Claims Analyst III
Trend Health Partners
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $70,000 - $80,000 per year
About the role
- 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 and resolve claim issues or seek clarifications.
- Identify new overpayment opportunities and trends 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.
- Interpret and analyze medical and pharmacy claims data as well as provider and enrollment data to accurately assess and demonstrate key insights into trends and opportunities and follow concept development process.
- Assist Management with concept approval information needed for client approval on specific trends.
- Complete step by step instructions for each algorithm moved to production.
- 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.
- Train and assist new analysts as needed while maintaining high quality and production results.
- Assist with Quality Review process.
- Ensure staff is appropriately resolving day-to-day problems in a timely and successful manner
Requirements
- Bachelor’s degree in accounting, business, healthcare, or a related field
- Equivalent work experience in a similar position may be substituted for educational requirement.
- Experience in identification, analysis, and recovery of claim overpayments
- Strong understanding of calculations and medical terminology
- Excellent computer skills and proficient in Excel
- Strong analytical and problem-solving skills
- Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with providers, management, and peers
Benefits
- competitive salaries
- highly valued health insurance
- a 401(k) plan with employer match
- paid parental leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claim overpayments recoveryclaims validationdata analysisalgorithm effectivenessmedical terminologycalculationsquality reviewconcept developmentExcel proficiency
Soft Skills
analytical skillsproblem-solving skillscommunication skillsinterpersonal skillsteam collaborationfeedback provisiontraining and mentoringprofessional representationrelationship building
Certifications
Bachelor’s degree in accountingBachelor’s degree in businessBachelor’s degree in healthcare