Claims Analyst I

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

📋 Description

• Gain an understanding of clients’ claims adjudication systems, as well as member and provider contracts, and procedures related to claim payments.

• Aid clients in discovering, validating, and recovering overpayments on claims.

• Verify claims for algorithm accuracy and ensure that no refunds have been previously issued.

• Evaluate and address disputed overpayments from clients or providers.

• Engage in knowledge sharing to tackle claim-related issues and seek clarifications.

• Identify new opportunities for overpayments by investigating CMS and Medicaid claims processing policies, client adjustments, claims policies and systems, and contracts with providers and members.

• Generate, test, document, and propose new overpayment trends and research scenarios.

• Explore new concepts and adhere to the algorithm development process.

• Support Management with information needed for client approval on specific trends.

• Represent TREND and its clients in a professional manner.

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

• Provide Management with insights regarding inventory levels, algorithm effectiveness, productivity, and emerging trends or ideas.

• Work with TREND Management to pinpoint opportunities, enhancements, and innovative solutions.

• Escalate issues beyond the employee’s control that could negatively affect business relationships.

⛳️ Requirements

• Bachelor’s degree in accounting, business, healthcare, or a related field; relevant work experience in a similar role may be accepted in lieu of educational qualifications.

• High School Diploma or Equivalent is required.

• Proficient computer skills, particularly in Excel.

• Strong analytical capabilities.

• Excellent communication and interpersonal skills.

• Keen attention to detail.

• Proven ability to solve problems effectively.

• Exceptional written and verbal communication skills.

• Strong organizational and time management skills.

• Highly analytical, self-motivated, and proactive.

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

• Experience with medical claims processing is preferred.

• Prior experience in identifying, analyzing, and recovering claim overpayments is preferred.

🏝️ Benefits

• Competitive salaries.

• Health insurance coverage.

• 401(k) plan with employer matching.

• Paid parental leave.

• Performance-based incentive program.