Job Description
19843
Job Title: Claims Analyst
Location: Fully Remote (live in Raleigh, NC area)
Working Hours: 8 AM to 5 PM (Daily)
Company Overview:
Join our dedicated team committed to delivering high-quality claims management! As a leader in the staffing industry, we strive to connect talented professionals with opportunities that enhance their careers. Our organization values innovation, integrity, and collaboration, and we are looking for a skilled Claims Analyst to contribute to our mission.
Position Overview:
As a Claims Analyst, you will play a crucial role in ensuring the integrity and quality of claims management. You will be responsible for generating, reviewing, and optimizing claims to ensure compliance with state, federal, and SSAE/SOC policies. This position demands a detail-oriented individual who can proficiently analyze data throughout the entire adjudication lifecycle.
- Key Responsibilities:
- Analyze and assess the development of claims at each level of the adjudication process to ensure compliance with relevant regulations.
- Outline case strategies and develop comprehensive Theories of the Case for each individual claim.
- Write and prepare detailed case summaries to accompany applications.
- Monitor and provide direction to Claims Developers on specific tasks associated with claims.
- Prepare monthly reporting statistics to track performance and outcomes.
- Ensure compliance with claim timeliness and accuracy performance standards.
- Participate in various meetings, including status reports and process improvement sessions, to discuss claim statuses and required data collection.
- Assist with quality control projects by conducting case reviews to maintain the integrity of claim methodologies and eligibility determinations.
- Support the preparation of written reports and materials for clients to communicate findings and insights effectively.
- Required Skills and Qualifications:
- High School Diploma or equivalent required; Bachelor’s Degree preferred.
- Minimum of 2 years of experience in Medical Claims processing.
- Strong ability to evaluate, coordinate, and manage complex planning and administrative tasks.
- Proven ability to build and maintain collaborative relationships with federal, state, and county agency staff.
- Proficiency in Microsoft applications and the ability to work with large volumes of claims while effectively prioritizing workload.
- Exceptional organizational, oral presentation, and written communication skills.
- Capacity to work independently and as part of a team.
- Experience or knowledge in state government, health insurance payment systems (especially Medicaid), or cost accounting is highly advantageous.
- Understanding of applicable laws, regulations, and government agencies related to claims processing.
Pay: $21.00 - $31.00 per hour
- Benefits:
- Health insurance
- Education:
- Bachelor's (Preferred)
- Experience:
- Medical billing: 3 years (Required)
- State Government Health Insurance: 1 year (Required)
Work Location: Remote
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