Claims Analysts

Job Responsibilities:

• Reviewing insurance claims filed by policyholders and/or providers to ensure they are accurate and complete.

• Responsible for applying business knowledge and skills to assist, organize and coordinate projects.

• Provide support that will improve or enhance the administration of benefits through claims processing and other supporting functions.

• Your duties include monitoring each claim throughout the process.

• Gather, analyze and interpret health care data.

• Evaluates claims referred for medical management and makes recommendations for follow-up, further investigation, or documentation as necessary.

Qualifications:

• High School diploma or equivalent is required.
• Experience with HealthEdge HealthRules Payor (HRP) is strongly preferred.
• Experience with Covered CA or Market Place line of business is strongly preferred. 
• A minimum of 2 years Claims Processing experience required. 
• Ability to think critically.
• Excellent written and verbal skills.
• Demonstrate analytical and problem-solving skills.

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.