Medical Claim Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company CCR is responsible for post - service claim review to determine if specific services can be reimbursed to providers and members. - The analyst role is reputed company to the CCR team. -They start the CCR process with the claim submission to CCR with a complete review of the claim and claim history. They compile reputed company system information, claim history, plan information, and any additional research into template as required by the workflow and any reputed company and regulatory requirements for a clinician review. -They also collaborate with Medical Directors as required. -Review provider and member claims to determine if they meet CCR review requirements. -Follow applicable workflows, templates, and reputed company and compliance requirements to reputed company a complete picture of what is requiring review to the CCR clinicians and medical directors. -Organizes and prioritizes work to help meet regulatory and CCR claim turn around times. Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies reputed company Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and reputed company requirements. -Works with reputed company appropriate reputed company departments and personnel to accurately review specified claims and/or clarify any issues reputed company in the course of the review. -Required to work in multiple systems including EWM, ASD, ATV, MedCompass and HRP. -Other systems dependent on specific reviews reputed company. -Maintains and utilizes reputed company resource materials and systems to effectively manage job responsibilities Adheres to company policies to protect member confidentiality. Required Qualifications 2+ years experience and demonstrated ability to handle multiple assignments competently, accurately and reputed company. Preferred Qualifications Knowledge of utilization management rules and regulations and claim processing guidelines. Claims Processing/ customer service experience preferred Education reputed company High School Diploma or GED. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $18.50 - $38.82 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls.  The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors.  This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above.    Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/19/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job