Claims Analyst

Engagement Description –

• Reviewing claim submissions and verifying claims processed correctly.

• Auditing claims-making sure the system applied the correct benefits, pricing, and cost share values.

o Comparing claims data to the members benefits and other policy documents.

o Ensuring the system applied to correct allowed amounts using CMS fee schedules.

o Confirmed system applied the correct member cost share amounts based on benefit documents.

• Performing other clerical tasks, as required.

Top 3 Required Skills/Experience –

• 5 years medical claims experience (HCFA and UBs)

• In depth knowledge of medical claim coding

• Proficient in Microsoft Word and Excel

Required Skills/Experience – The rest of the required skills/experience. Include:

• Excellent critical thinking and decision-making skills.

• Good administrative and organizational skills.

• Ability to work under pressure, perform a range of clerical functions with great attention to detail.

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Medicare claims and compliance experience

• Comfortable working independently

• Understands the importance of deadlines

Category Analyst

Function Information Technology

Req ID JN -082023-120355