Claims Analyst

Job Summary

A company is looking for a Claims Analyst II to ensure timely processing of complex medical claims.

Key Responsibilities

• Process complex first-time claims and determine reimbursement eligibility
• Research and resolve claims related to adjustments, provider calls, and appeals
• Maintain records and documentation while meeting department production and quality standards

Required Qualifications

• High school diploma or equivalent required; Associate degree preferred
• 2+ years of health insurance or claims-related experience required
• Intermediate PC and Microsoft Office skills; basic math proficiency required
• Medical coding knowledge (ICD 9/10, CPT, HCPCS) preferred
• Experience with Medicaid, Marketplace, or Medicare claims preferred