Medical Claim Analyst

Job Summary

Medical Claim Analyst, this full-time position involves post-service claim review to determine reimbursement eligibility for providers and members, requiring collaboration with Medical Directors and adherence to regulatory requirements.

Key Responsibilities

• Conduct post-service claim reviews and compile necessary documentation for clinician review
• Verify coverage, eligibility, and benefits while identifying discrepancies in claims
• Collaborate with internal and external departments to resolve issues during the claim review process

Required Qualifications

• 2+ years of experience in a relevant field
• Demonstrated ability to manage multiple assignments accurately and efficiently
• Verifiable High School Diploma or GED
• Knowledge of utilization management rules and claim processing guidelines preferred
• Claims processing or customer service experience is advantageous