Claims Analyst I

This is a fully remote position, open to applicants in United States.

📋 Description

• Gain a comprehensive understanding of the client’s claims adjudication system(s), as well as member and provider contracts, and the client's claim payment policies and procedures.

• Assist the client in pinpointing, validating, and recovering overpayments on claims.

• Validate claims to ensure the algorithms' accuracy and confirm that no refunds have been previously recorded in the client's system(s).

• Review and address disputed overpayments from clients/providers.

• Engage in knowledge-sharing sessions to collaboratively brainstorm and resolve claim issues or seek clarifications.

• Identify new overpayment opportunities through reviews and research of areas such as CMS and Medicaid claims processing policies, adjustments by the client’s internal unit or other vendors, and the client’s claims processing policies/system(s), including provider and member contracts.

• Conceptualize, test, document, and present new overpayment trends and research scenarios.

• Investigate potential new ideas and adhere to the algorithm development process.

• Support Management with necessary concept approval information for client endorsement of specific trends.

• Consistently represent TREND and our clients in a professional manner.

• Collaborate with team members to achieve goals and complete tasks efficiently and effectively.

• Provide Management with feedback regarding inventory levels, algorithm effectiveness/productivity, and new trends/ideas.

• Work alongside TREND Management to identify new opportunities, areas for improvement, and innovative potential solutions.

• Report to the manager any situations beyond the employee’s control that could negatively affect the business relationship.

⛳️ Requirements

• A Bachelor’s degree in accounting, business, healthcare, or a related field; equivalent work experience in a similar role may be accepted in place of educational requirements.

• Proficient computer skills, especially in Excel.

• Strong analytical capabilities.

• Excellent communication and interpersonal skills, demonstrating the ability to connect and build relationships with payers, providers, clients, management, and colleagues at all levels.

• Keen attention to detail.

• Proven ability to solve problems effectively.

• Outstanding written and verbal communication skills.

• Effective organizational and time management skills.

• Highly analytical, self-motivated, and goal-oriented.

• Ability to learn, comprehend, and implement new technologies.

• A High School Diploma or equivalent is required.

🏝️ Benefits

• Competitive salaries.

• Highly valued health insurance.

• A 401(k) plan with employer match.

• Paid parental leave.