Medical Claims Review Analyst

Job Summary

A company is looking for a Medical Claims Review Analyst.

Key Responsibilities

• Review and triage selected medical claims to determine eligibility for clinical review
• Request, obtain, and organize medical records from providers
• Research and process incoming documentation to support claim review activities

Required Qualifications

• High school diploma or GED with approximately 3+ years of experience in a healthcare setting
• Experience working with healthcare documentation including medical records and claims data
• Working knowledge of medical terminology, anatomy, and healthcare processes
• Familiarity with claims systems such as Facets is a plus
• Strong analytical and organizational skills with the ability to prioritize tasks