Claims Analyst

SUMMARY: The Claims Analyst is responsible for analyzing a percentage of processed claims for accuracy according to the provider contract and company policies and procedures by performing the following and other duties that may be assigned.

ESSENTIAL FUNCTIONS

• Conduct audits and reviews of claims. Document the findings and recommendations. 
• Request all information from internal or outside sources to ascertain completeness and validity of claims.
• Analyze claim trends to determine any necessary refinement of business rules and workflows in order to improve the overall claims process.
• Contribute to the development of claims analysis reports.
• Research claims as needed. 

REQUIRED SKILLS AND ABILITIES

• Displays written and verbal communication skills with administration and external parties.
• Able to work collaboratively, diplomatically, maintain confidentiality, and with integrity in problem identification and problem solving activities.  
• Displays knowledge of ethical principles and compliance issues in an accounting setting.  
• Knowledge of claims processing. 
• Possesses good organizational skill, ability to focus on assigned tasks.

QUALIFICATION

• High School Graduate or equivalent. Some college preferred. 
• Minimum 2 years of relevant claims processing experience, preferably in a health care environment or a minimum of six months of internal claims processing experience. 
• Strong written and verbal communication skills. 
• Basic working knowledge of excel and Microsoft office.