BusinessOperations – Claims Analyst 2 Claims Analyst 2 Position Available In Nash, North Carolina
Tallo's Job Summary: The Claims Analyst 2 position in Business Operations involves processing medical claims, verifying information, and determining reimbursement eligibility. Responsibilities include organizing records, reviewing claim forms, and providing customer service. Requirements include a high school diploma, 2-4 years of experience, and familiarity with VLookup and pivot tables. Centene is hiring for this role, offering remote work in the EST zone.
Job Description
BusinessOperations – Claims Analyst 2 Claims Analyst 2#25-57962
Rocky Mount, NC
All On-site Job Description
Job Description:
Summary:
The main purpose of a Claims analyst is to process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.
Job Responsibilities:
Organize and work with detailed office or warehouse records, using computer to enter, access, search and retrieve data. Prepare and review insurance claim forms and related documents for completeness. Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors. Review claims to determine whether or not claimant is covered under a policy, review policy to determine coverage, and evaluate the extent of a settlement. Authorize claim payments, set reserves on payments, ensure timely disbursement of funds, coordinate or conduct investigations on claims, identify claims with possible recovery from third parties, and consult with attorneys, doctors, and agents in regards to the disposition of complex claims.
Education/Experience High school diploma or GED required. Bachelor’s degree in Business or related field preferred. 2-4 years experience required.
Comments for
Vendors:
Also would like for the resource to have experience with VLookup and pivot tables. Candidate location anywhere in EST zone for remote position.
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” ===========
Centene Job Description
Summary:
The main purpose of a Claims analyst is to process vision routine/medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.
Job Responsibilities:
Organize and work with detailed office or warehouse records, using computer to enter, access, search and retrieve data. Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors. Review claims to determine whether or not claimant is covered under a policy, review policy to determine coverage, and evaluate the extent of a settlement. Authorize claim payments, set reserves on payments, ensure timely disbursement of funds, coordinate or conduct investigations on claims, identify claims with possible recovery from third parties. Education/Experience High school diploma or GED required. Bachelor’s degree in Business or related field preferred. 2-4 years experience required.
Story Behind the Need What is the purpose of this team?
Describe the surrounding team (team culture, work environment, etc.) & key projects.
Do you have any additional upcoming hiring needs or is this request part of a larger hiring initiative? The adjustment team is responsible for reprocessing claims that were previously paid/denied incorrectly. The requests are received via Track-it application.
The team has a great working relationship and communicates very well with each other. Providing positive and negative feedback. Typical Day in the Role Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
What are the performance expectations/metrics?
What makes this role unique? The individual will need to be able to multi-task; some days the workload may require splitting a day’s work with different tasks. Work on adjusted claims via our Track-It and Risk Manager application, apply refund checks, projects (identified larger volume of adjusted claims maybe from the same office and/or same issue), and reports. Items should be completed prior to close out days on Mondays and Wednesdays.
Individuals must meet quality of 97% and production of 100%
The employee will be introduced to the team, go over applications/systems, complete online onboarding courses, compliance trainings, and have training sessions schedule for each individualized assignment.
We work as a team, we are fully remote, the department is crossed trained to handle all assignments. Candidate Requirements
Education/Certification
Required:
High School Diploma
Preferred:
Licensure
Required:
N/A
Preferred:
Years of experience required: 6 months or more
Disqualifiers:
NA Additional qualities to look for: Also, would like for the resource to have experience with VLookup and pivot tables. Candidate location anywhere in EST zone for remote position. Top 3 must-have hard skills stack-ranked by importance 1 Claims Processing
2 Medical Terminology
3 Health Insurance Knowledge
Candidate Review & Selection Shortlisting process
Candidate review & selection
Interview information
Onboard process and expectations
Projected Manager Candidate Review Date:
ASAP Type of Interviews:
Teams,
Required Testing or Assessment (by Vendor):
