CLAIMS ANALYST - TPA

This position examines, enters and accurately adjudicates medical, dental, vision, or STD claims based upon coverage, policy and procedural guidelines. Reviews claims in a timely and accurate manner, performing auditing functions in compliance with client coverage and claim processing policies and procedures. May be assigned multiple clients with several lines of coverage.

Experience: A High School Degree or equivalent. Medical terminology and medical claims experience with involvement in reviewing and analyzing claims is beneficial.

Critical Required Skills:

• Must be able to work well independently and in a team atmosphere.
• Ability to maintain a departmental accuracy standard of 99%.
• Detail oriented.
• Ability to manage multiple priorities that change from day to day and week to week in a fast-paced environment.
• Ability to research and respond to requests for pre-determination of benefits.
• Ability to understand system calculations in order to determine if claims are adjudicating accurately.
• Ability to manually process claims in the claims adjudication system if necessary.
• Must understand complicated benefit designs.
• Ability to self-manage, prioritize and meet specific production deadlines.
• Ability to communicate professionally verbally and in writing appropriate to the audience.
• Computer experience, including Word, Excel, and Outlook.
• Accurate 10-key and/or data entry skills.