Medical Claims Analyst

Job Summary

Working remotely, the full-time Medical Claims Analyst will be responsible for the timely and accurate processing and adjudication of Medical, Dental, and Vision claims while ensuring compliance with plan provisions and regulatory requirements.

Key Responsibilities

• Process and adjudicate routine Medical, Dental, and Vision claims accurately and within required timelines
• Review and interpret benefit plans, contracts, and coverage provisions to support accurate payment decisions
• Communicate effectively with members, clients, and providers to resolve inquiries and escalate complex claims as needed

Required Qualifications

• High school diploma or equivalent required
• 0-1 year of medical claims or related experience preferred
• Basic understanding of medical terminology and insurance concepts
• Strong computer and data entry skills
• Commitment to confidentiality and compliance with HIPAA regulations