Medical Claims Analyst
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Job Description
Job Description
We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida. This role involves managing the revised claims process, leading a team of claims processors, and ensuring claims are filed in a timely manner.
Responsibilities:
Oversee the end-to-end process of claims submission, evaluation, and resolution in compliance with company policies
Review claims to ascertain their validity, completeness, and compliance with policy terms
Communicate with members, healthcare providers, and other stakeholders to gather necessary information and provide updates on the status of claims
Lead and mentor a team of claims specialists, providing guidance, training, and support to ensure productivity and quality of work
Monitor claims data, generate reports, and analyze trends to identify areas for improvement in the claims process
Ensure that the claims process complies with all relevant regulations, policies, and procedures, including state and federal laws governing healthcare and insurance
Address any disputes or escalations related to claims, working to resolve issues in a fair manner to both the company and the member. Proficiency in Allscripts and Cerner Technologies required
Familiarity with Cl Programming and CMS Platform necessary
Must have strong computer skills and be comfortable with various computer programs
Experience in handling appeals in the insurance industry preferred
Proven track record in auditing, ideally in the medical claims field
Knowledge of benefit functions within the insurance industry required
Familiarity with billing functions, particularly in the healthcare sector
Must have experience in claim administration within the insurance industry
Ability to work in a team and communicate effectively with different stakeholders
Strong analytical skills and attention to detail
Knowledge of insurance industry regulations and guidelines
Ability to handle sensitive information with utmost confidentiality
Must have excellent problem-solving skills and a strong work ethic
Bachelor's degree in a related field or equivalent work experience required.
Responsibilities:
Oversee the end-to-end process of claims submission, evaluation, and resolution in compliance with company policies
Review claims to ascertain their validity, completeness, and compliance with policy terms
Communicate with members, healthcare providers, and other stakeholders to gather necessary information and provide updates on the status of claims
Lead and mentor a team of claims specialists, providing guidance, training, and support to ensure productivity and quality of work
Monitor claims data, generate reports, and analyze trends to identify areas for improvement in the claims process
Ensure that the claims process complies with all relevant regulations, policies, and procedures, including state and federal laws governing healthcare and insurance
Address any disputes or escalations related to claims, working to resolve issues in a fair manner to both the company and the member. Proficiency in Allscripts and Cerner Technologies required
Familiarity with Cl Programming and CMS Platform necessary
Must have strong computer skills and be comfortable with various computer programs
Experience in handling appeals in the insurance industry preferred
Proven track record in auditing, ideally in the medical claims field
Knowledge of benefit functions within the insurance industry required
Familiarity with billing functions, particularly in the healthcare sector
Must have experience in claim administration within the insurance industry
Ability to work in a team and communicate effectively with different stakeholders
Strong analytical skills and attention to detail
Knowledge of insurance industry regulations and guidelines
Ability to handle sensitive information with utmost confidentiality
Must have excellent problem-solving skills and a strong work ethic
Bachelor's degree in a related field or equivalent work experience required.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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