Claims Analyst

Job Description

Our Payment Accuracy team is seeking a talented Claims Analyst to assist clients in revenue cycle reconciliation. The Claims Analyst will be responsible for researching and analyzing data, systems and documents to develop new concepts or apply existing concepts to identify claim overpayments.

Responsibilities

• Acquire knowledge of the client’s claim adjudication system, member and provider contracts and client claim payment policies and procedures

• Assist clients in identifying, validating and recovering claim overpayments
• Validate claims to ensure the accuracy of algorithms and it has not been previously identified
• Identify new overpayment opportunities through review and research
• Interpret and analyze data to accurately assess and demonstrate key insights into trends and new opportunities
• Research potential new ideas and follow algorithm development process
• Provide feedback to management regarding inventory levels and algorithm effectiveness

Qualifications

• Bachelor’s degree in accounting, business, healthcare or a related field
• Equivalent work experience in a related field may be substituted for educational requirements
• Excellent computer skills and proficient in Excel
• Strong analytical skills
• Strong communication skills, both written and verbal

Preferred Skills

• Experience with medical claims processing
• Experience in identification, analysis and recovery of claim overpayments