Senior Claims Analyst

This is a fully remote position, open to applicants in Connecticut, +4 more states.

📋 Description

• Conduct research, process, and resolve claims of varying complexity levels.

• Manage intricate situations and prioritize project tasks based on time-sensitive requirements.

• Collaborate with different departments to address complex claim inquiries and investigate issues.

• Execute claim adjustments and manage claim-related correspondence.

• Analyze and work on detailed reports that encompass adjustments, overrides, copayments, coinsurance, pricing, provider selection, and maximum out-of-pocket concerns.

• Engage in meetings with clients, vendors, and internal teams as a Claims subject matter expert.

• Make outbound calls to members, providers, hospitals, vendors, or other sources to resolve outstanding issues.

• Act as a resolution escalation point for colleagues.

• Provide coaching, mentoring, and support to junior team members.

• Lead initiatives focused on payment integrity, including vendor interactions, adjustment findings, and reporting.

• Identify and address gaps in claim processing and system management.

• Adhere to established desk procedures while working under limited supervision.

⛳️ Requirements

• High school diploma, GED, or an equivalent qualification.

• Over 3 years of experience in a similar role, or possess the necessary knowledge, skills, and abilities to thrive in this position.

• Advanced knowledge of Facets claims processing and adjustment practices.

• In-depth understanding of Medicare/MAO claims processing.

• Comprehensive knowledge of departmental workflows, processes, and procedures.

• Highly adept at researching and comprehending complex information, including government regulations and contracts.

• Proficient in solving complex or ambiguous issues.

• Exceptional attention to detail.

• Capability to operate in a fast-paced environment with multiple competing priorities.

• Flexibility and adaptability to frequently evolving guidelines and processes.

• Solid understanding of Federal, State, and local healthcare regulations.

• Strong collaboration skills and effective written and verbal communication abilities.

• Proficient in Microsoft Office Suite and other business applications.

• Experience with 10-key and excellent typing skills.

• Sense of urgency and ability to switch effectively between tasks.

• Basic experience in educating peers about departmental processes and procedures.

• Must be authorized to work in the United States; visa sponsorship is not available.

• Preferred: Bachelor's degree.

• Preferred: Experience with CMS Audits.

🏝️ Benefits

• Medical, Vision, and Dental Plans.

• Tax-Advantaged Savings Accounts (FSA & HSA).

• Life Insurance and Disability Insurance.

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days).

• Employee Assistance Program.

• 401k with company match.

• Employee Resource Groups.

• Employee Discount Program.

• Learning and Development Opportunities.

• Performance-based incentives and/or equity may be available depending on the position.

• Approved COVID-19 vaccination requirement for personnel interacting with at-risk members or prospects.