Claims Resolution Analyst

Job Summary

Working remotely, the full-time Claims Resolution Analyst will review and research suspended claims, identify and resolve issues, and ensure claims are processed in accordance with DVHA guidelines.

Key responsibilities

• Review and research suspended claims per DVHA guidelines
• Refer claims to the appropriate department for further review when necessary
• Prepare and issue Return to Provider (RTP) notices for incomplete or incorrect claims

Required qualifications

• Proficiency in Microsoft Excel and Outlook
• Ability to train backup or replacement staff as needed
• Strong reading comprehension skills to interpret guidelines, policies, and procedures
• Experience in claims processing with a focus on detail and accuracy
• Flexibility to adapt to changing priorities