Claims Resolution Analyst

Job Summary

A company is looking for a Claims Resolution Analyst responsible for coordinating the resolution of claims issues within the health plan.

Key Responsibilities

• Investigates and facilitates the resolution of claims issues by analyzing systems and processes across multiple operational areas
• Coordinates efforts among internal departments to resolve issues within strict timelines
• Performs claims and trend analysis, ensuring documentation accuracy and obtaining necessary approvals to close claims issues

Required Qualifications

• Requires a BA or BS degree
• 5-7 years of claims experience
• Minimum 1 year of experience in complex claims research and issue resolution within the managed care industry
• Any combination of education and experience that provides an equivalent background may be considered