Claims Analyst II

Job Summary

Ensuring timely processing of complex medical claims, the full-time Claims Analyst II will verify information, determine reimbursement eligibility, and communicate with stakeholders while working remotely.

Key responsibilities

• Process first-time claims with added complexity and apply policy provisions to determine claim payability
• Research and resolve status of medical claims, including adjustments and appeals
• Maintain records and documentation while meeting department production and quality standards

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
• Knowledge of medical coding (ICD 9/10, CPT, HCPCS) preferred
• Experience with Medicaid, Marketplace, or Medicare claims preferred