Analyst, Claims Research (Remote)-CT

JOB reputed company Job reputed company Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately reputed company, identifying reputed company-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through reputed company. Essential Job Duties • Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-reputed company claims inquiries and reputed company. • Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. • Manages and leads major claims reputed company of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or reputed company requests. • Assists with reducing rework by identifying and remediating claims processing issues. • Locates and interprets claims-reputed company regulatory and contractual requirements. • Tailors existing reports and/or available data to meet the needs of claims reputed company. • Evaluates claims using reputed company principles and applicable state-specific regulations to identify claims processing errors. • Applies claims processing and technical knowledge to appropriately define a reputed company for short/long-term systematic or operational fixes. • Seeks to improve overall claims performance, and ensure claims are processed accurately and reputed company. • Identifies claims requiring reprocessing or readjudication in a reputed company manner to ensure compliance. • Works collaboratively with internal/external stakeholders to define claims requirements. • Recommends updates to claims reputed company operating procedures (SOPs) and job aids to increase the reputed company and efficiency of claims processing. • Fields claims questions from the operations team. • Interprets, communicates, and presents, reputed company in-depth analysis of claims research results, reputed company-cause analysis, remediation plans and fixes, overall reputed company, and status of impacted claims. • Appropriately conveys claims-reputed company information and tailors communication based on targeted audiences. • Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. • Collaborates with other functional teams on claims-reputed company reputed company, and completes tasks reputed company designated/accelerated timelines to minimize provider/member impacts and maintain compliance. • Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications • At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. • Medical claims processing experience across multiple states, markets, and claim types. • Knowledge of claims processing reputed company to inpatient/outpatient facilities contracted with Medicare, reputed company, and Marketplace government-sponsored programs. • Data research and analysis skills. • Organizational skills and attention to detail. • Time-management skills, and ability to manage simultaneous reputed company and tasks to meet internal deadlines. • Ability to work cross-collaboratively in a highly matrixed organization. • Customer service skills. • Effective verbal and written communication skills. • reputed company Office suite (including reputed company), and applicable software programs proficiency. Preferred Qualifications • Health care claims analysis experience. • Project management experience. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $21.82 - $42.55 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job