Trend Health Partners

Claims Analyst I

Trend Health Partners

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $50,000 - $60,000 per year

About the role

  • Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures.
  • Assist client in identifying, validating, and recovering claim overpayments.
  • Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s)
  • Review and resolve disputed overpayments from client/provider.
  • Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications.
  • Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts.
  • Ideate, test, document & submit new overpayment trends/research scenarios.
  • Research potential new ideas and follow algorithm development process.
  • Assist Management with concept approval information needed for client approval on specific trends.
  • Always represent TREND and our clients in a professional manner
  • Cooperate with team members to meet goals and complete tasks in an efficient and effective manner.
  • Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas.
  • Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions.
  • Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.

Requirements

  • Bachelor’s degree in accounting, business, healthcare, or a related field
  • Excellent computer skills and proficient in Excel
  • Strong analytical skills
  • Strong communication and interpersonal skills
  • Attention to detail
  • Proven problem-solving abilities
  • Excellent written and oral communication skills
  • Effective organization, time management skills
  • Highly analytical, self-motivated, and directed
  • Must be able to learn, understand, and apply new technologies
  • High School Diploma or Equivalent Required
Benefits
  • highly valued health insurance
  • 401(k) plan with employer match
  • paid parental leave
  • performance-based incentive program
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims adjudicationclaims processingalgorithm developmentdata validationoverpayment recoveryresearchdocumentationproblem-solvingExcel
Soft Skills
analytical skillscommunication skillsinterpersonal skillsattention to detailorganization skillstime managementself-motivatedcollaborationfeedback provision
Certifications
Bachelor’s degreeHigh School Diploma or Equivalent