Medical Claim Analyst

Job Summary

Medical Claim Analyst, this full-time position involves reviewing post-service claims to determine reimbursement eligibility for providers and members, requiring collaboration with Medical Directors and adherence to legal and compliance requirements.

Key Responsibilities

• Conduct post-service claim reviews to assess reimbursement eligibility
• Organize and prioritize work to meet regulatory and claim turnaround times
• Collaborate with internal and external departments to clarify claim issues

Required Qualifications

• 2+ years of experience in a relevant field
• Ability to handle multiple assignments accurately and efficiently
• Knowledge of utilization management rules and regulations
• Experience in claims processing or customer service preferred
• Verifiable High School Diploma or GED