Claims Investigation Analyst

Job Summary

Working remotely in a full-time capacity, the Claims Investigation Analyst will review and resolve complex claims issues while acting as a liaison between providers and Health Plan departments, ensuring accurate communication and adherence to established guidelines.

Key responsibilities:

• Evaluate and resolve complex claim and provider billing issues in a timely manner
• Educate providers on claims submission requirements and facilitate issue resolution
• Document inquiries and complaints accurately while identifying trends to improve processes

Required qualifications:

• High School Diploma or Equivalent (GED) required
• Minimum of 4 years of relevant experience required
• Experience with state and federal guidelines related to claims processing
• Ability to provide professional guidance and support to providers
• Familiarity with claims audits and payment terms configuration