Medical Claim Analyst

Job Description: • Responsible for initial review and triage of claims tasked for review. • Determines coverage, verifies eligibility, identifies and redirects misdirects • Responsible for prepping the authorization in the system and triage cases to medical staff for review. • Organized and prioritizes work to meet regulatory and claim turn-around times • Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team. • Performs non-medical research and support • Adheres to Compliance with PM Policies and Regulatory Standards. • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. • Protects the confidentiality of member information and adheres to company policies regarding confidentiality. • Assist in the research and resolution of claims payment issue Requirements: • 2-4 years experience as a medical assistant, office assistant or claim processor • Familiarity with basic medical terminology and concepts used in care • Effective communication, telephonic and organization skills • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word • MedCompass, CEC, or ACAS (preferred) Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job Apply To this Job