Associate Analyst, Claims Research

Job Description
JOB DESCRIPTION Job Summary
Provides entry level analyst support for claims research activities. Ensures timely and accurate resolution of provider submitted claims issues/inquiries. Leverages understanding of medical claims processing and uses analytical skills to effectively triage issues to facilitate claims investigation or correction. Meets established production and quality standard. Identifies trends in claims issues to inform process improvements and drive continuous improvement in claims performance and compliance.

Essential Job Duties

• Reviews and analyzes claims-related issues submitted by providers to identify potential root-cause issues; triages issues quickly and accurately.
• Triages issues based on type and complexity, assigning to the appropriate department or team for further research or correction.
• Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate claims assessments.
• Meets quality and production goals.
• Maintains detailed records of claim reviews and resolutions.
• Identifies trends in submitted issues to inform process improvements and reduce recurring errors.
• Provides feedback and recommendations for process improvements related to provider claims research.

Required Qualifications

• At least 1 year of experience in medical claims processing/research and/or health care operations , or equivalent combination of relevant education and experience.
• Basic medical claims processing knowledge.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service skills.
• Problem-solving skills.
• Ability to work independently and as part of a team, and collaborate cross-functionally across a highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency.

Preferred Qualifications

• Experience with process improvement methodologies.
• Knowledge of industry regulations and compliance standards.
• Familiarity with systems used to manage claims inquiries and adjustment requests.
• Understanding of billing and coding procedures.
• Experience with Medicaid, Medicare, and Marketplace claims.