Lead Claims Analyst

Job Summary

Providing oversight and technical support, the full-time Lead Claims Analyst will coordinate daily operations of the claims unit, investigate complex issues, and ensure compliance with company practices while working remotely.

Key responsibilities

• Oversee and support Claims Analysts in applying policy and contract provisions to determine claim payability
• Train and mentor claims analysts, reinforcing claims training and development
• Review, investigate, and resolve complex claims and serve as the first point of escalation for issues

Required qualifications

• High school diploma or equivalent; associate degree or equivalent experience preferred
• Minimum of 2 years of claims processing experience, specifically with Medicaid, Marketplace, or Medicare claims
• Proficiency in Microsoft Office, particularly Word and Excel
• Knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology
• Completion of claims basic training and COB advanced training required