Claims Analyst

Claims Analyst Countryside, IL Job Details $29.82 an hour 15 hours ago Qualifications SFTP Microsoft Excel Financial data reconciliation Phone communication Writing skills Data reporting Mid-level Invoice processing Administrative experience High school diploma or GED Financial fraud investigation ICD-10 Task prioritization Customer support ticket management Organizational skills Productivity software Phone etiquette Associate's degree Medical terminology

Technical Proficiency DRG Full Job Description Job Overview:

The Claims Analyst position works under general supervision while conducting administrative activities for the Claims Department. These activities involve supporting Claims Management and Claims staff with claims related to administrative matters.

Essential Functions:

Investigate potential fraud providers to determine if they need to be flagged in ISSI Run biweekly check run process. Run and complete Management Inventory and Aging Report every Monday morning Delete claims from ISSI as requested Handle COC letter processing and file updates Back up annual 1099-M process Back-up Workflow Coordinator Identify system processing trends to share with Programming analyst for comprehensive analysis Run standard pre-designed departmental reports upon request Prepare and maintain daily/weekly production reports Compile and prepare audit review data for management review Remove members from auto adjudication as needed. Cobine SFTP files as needed Assist with table updating Reconcile weekly check run dollars and numbers Prepare monthly claim invoices for review Verify if BCBS has made payments on claims. Review and reconcile Wex daily bank settlements Reconcile Zelis OON claim reports Assist with implementation projects Distribute pend reports from the ISSI system. Maintain department issue log and projects Coordinate with Programming Analyst, Vendors, and Operations on system enhancements Manage OneDesk Tickets Prepare annual RMSP payment files Other duties as assigned.

Education and Experience:

High School diploma or equivalent; associate degree preferred

Competencies:

Must be able to maintain a high level of confidentiality. Must be flexible and have great organizational skills. Ability to multi-task, prioritize and work efficiently. Ability to build rapport and meaningful relationships with other departments. Ability to work independently, self-starter, energetic. Ability to demonstrate good common sense and sound judgment. Ability to communicate clearly and professionally, both verbally and in writing.

Specialized Skills/Technical Knowledge:

Knowledge of medical terminology and claims is desired but not required. Must be able to handle a high quality and productive environment. Appropriate office phone etiquette and ability to communicate professionally with external parties including attorneys and Plan participants. Knowledge of healthcare coding systems and methodologies such as CPT, ICD-10 and DRG. Must have excellent communication (written, verbal, listening) organizational, and problem-solving skills. Proficient in Microsoft Office applications, primarily Word and Excel.