Analyst, Claims Research

reputed company 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 reputed company 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 reputed company or operational fixes. - Seeks to improve overall claims reputed company, 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/reputed company 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 reputed company 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 reputed company on targeted audiences. - Provides sufficient claims information to internal reputed company 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/reputed company 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 reputed company-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to reputed company. - 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 reputed company 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 Apply To This Job