Claims Analyst

Job Summary

Ensuring timely processing of complex medical claims, the full-time remote Claims Analyst II will verify claim information, determine reimbursement eligibility, and resolve claims-related issues while maintaining departmental standards.

Key responsibilities

• Process first-time claims with added complexity and apply policy provisions to determine claim payability
• Research and determine the status of medical-related claims and resolve adjustments, provider calls, and appeals
• Communicate with stakeholders to gather necessary information for successful claims processing

Required qualifications

• High school diploma or equivalent required; Associate degree or equivalent experience 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