healthcare claims analyst

The Plastic Surgery Center

The Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates are the largest Reconstructive Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing superior patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees&mdash;whether caring for patients directly or working in a support role.We are seeking a Claims Dispute Specialist.The Claims Dispute Coordinator manages and resolves complex medical claim disputes and appeals with a focus on compliance with the Federal No Surprises Act (NSA) and similar state surprise billing laws. This role requires strong written communication skills, analytical skills and attention to detail. The ideal candidate brings the ability to efficiently prepare strong written arguments based on complex medical claims while effectively managing dispute process deadlines.Key Responsibilities <ul><li>Review and analyze medical claims to ensure accuracy, compliance, and eligibility for appeal or dispute under the NSA or state law</li><li>Investigate claim payments and denials by reviewing clinical documentation, insurance payer contracts, and claim history</li><li>Initiate and manage disputes under the NSA or state law</li><li>Prepare clear and effective written arguments as part of claims dispute processes</li><li>Analyze data and identify insights to support negotiations and dispute arguments</li><li>Collaborate with various teams within ARSA to ensure timely and successful dispute resolution</li></ul>Qualifications and Experience <ul><li>1&ndash;3 years in healthcare claims processing preferred</li><li>Experience with No Surprises Act dispute resolution highly preferred</li><li>Bachelor&rsquo;s degree relevant field preferred</li></ul>Skills <ul><li>Strong analytical and problem-solving abilities</li><li>Strong written and verbal communication skills</li><li>Strong organization skills</li><li>Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li><li>Proficiency in Microsoft Office suite and healthcare practice management systems</li></ul>Compensation &amp; Benefits:<ul><li>&middot; Pay Range: $55,000- $60,000annually</li><li>the starting rate within this range for this role varies depending on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies, experience, and location.</li><li>&middot; Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance</li><li>&middot; 401k and Profit sharing</li><li>&middot; Paid Time Off</li><li>&middot; Contribution to Health Benefits</li><li>Company Discounts on Products &amp; Services</li></ul>IND2Job Type: Full-timePay: $55,000.00 - $60,000.00 per yearExperience:<ul><li>Medical claims processinfg: 2 years (Required)</li><li>No Surprises Act: 2 years (Required)</li></ul>Ability to Commute:<ul><li>Red Bank, NJ 07701 (Required)</li></ul>Work Location: In person

Claims Dispute Specialist

Applied Underwriters

<div><div>Embark on a rewarding career journey at Applied Underwriters, where employees have been at the heart of our success story for more than 30 years. Headquartered in Omaha, NE, our company thrives on innovation and empowers our employees to shape the future of global risk services. Join a team where your ideas are valued and your talents are nurtured with formal, paid training and mentorship. Experience a workplace culture that celebrates initiative, recognizes results, and provides outstanding benefits that allow you to focus on achieving your full potential.</div>
<div>
The Healthcare Liability Claim Specialist oversees the investigation and resolution of complex, multi-state healthcare professional liability claims. You independently manage coverage analysis, liability evaluation, reserves, negotiations, and litigation strategy while partnering with insureds, counsel, and internal teams to deliver effective claim outcomes and underwriting insights.
</div>
<h3 class="jobSectionHeader">Requirements:
</h3><div><ul><li>Bachelor&rsquo;s degree.</li>
<li>4+ years of claim handling experience in healthcare professional liability or as an associate attorney defending healthcare liability litigation.</li>
<li>Proficient in Microsoft Office (Word, Excel, Outlook), and able to quickly learn claims management and case tracking systems.</li>
</ul></div><h3 class="jobSectionHeader">Our Benefits Include:
</h3><div><ul><li>100% employer-paid medical, dental, and vision insurance for employees</li>
<li>401(k) plan with 100% immediate vesting and a 4% company match</li>
<li>Paid time off (PTO) and paid holidays</li>
<li>On-site pharmacy, Promesa, provides convenient prescription delivery directly to you</li>
<li>Life, disability, critical illness and accident insurance</li>
<li>Employee Assistance Program (EAP)</li>
<li>Pre-tax Flexible Spending Accounts for health, dependent care, and commuter-related expenses</li>
<li>Tuition reimbursement</li>
<li>Fitness reimbursement and various additional quality-of-life benefits</li>
</ul></div><div>Applied Underwriters is a global risk services firm helping business and people manage uncertainty through its business services, insurance, and reinsurance solutions. As a company, we truly operate differently within our business sector. Applied Underwriters has one of the highest customer retention rates in the industry - a success directly attributed to our employees and their high level of commitment, hard work, and ambition.</div>

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.</div>

Claims Specialist, Healthcare Liability

FalconPrime Insurance Services

Claims AnalystFalconPrime Insurance Services &ndash; Doha, Qatar Full-timeAbout FalconPrime Insurance ServicesFalconPrime Insurance Services is a Doha-based insurance and risk management company providing comprehensive coverage solutions for individuals and businesses. The company focuses on efficient claims processing, customer satisfaction, and maintaining strong compliance with industry regulations.Job DescriptionFalconPrime Insurance Services is seeking a detail-oriented and analytical Claims Analyst to review, evaluate, and process insurance claims. The role involves ensuring claims are accurate, valid, and compliant with policy terms while supporting timely resolution and customer satisfaction.Claims Analysts play a key role in analyzing claim data, verifying coverage, and ensuring fair and accurate payouts while protecting company interests.Responsibilities<ul><li>Review and analyze insurance claims for accuracy, completeness, and eligibility</li><li>Evaluate policy coverage and determine claim validity</li><li>Investigate claims by gathering information from clients, adjusters, and relevant parties</li><li>Process claims and recommend approval, denial, or adjustment of payments</li><li>Identify discrepancies, errors, or potential fraudulent claims</li><li>Communicate with policyholders regarding claim status and requirements</li><li>Maintain accurate records of claims, documentation, and decisions</li><li>Prepare reports on claims trends, costs, and performance metrics</li><li>Ensure compliance with company policies and regulatory standards</li><li>Collaborate with internal departments such as underwriting, legal, and finance</li></ul>Qualifications<ul><li>Bachelor&rsquo;s degree in Finance, Business Administration, or related field</li><li>Previous experience in insurance claims, finance, or analysis preferred</li><li>Strong analytical and problem-solving skills</li><li>High attention to detail and accuracy</li><li>Good communication and interpersonal skills</li><li>Proficiency in Microsoft Excel and data analysis tools</li><li>Ability to manage multiple claims and deadlines</li></ul>Preferred Qualifications<ul><li>Experience in insurance, healthcare claims, or financial services</li><li>Knowledge of insurance policies, claims processing, and regulations</li><li>Familiarity with claims management systems or ERP software</li><li>Experience in fraud detection or risk analysis</li></ul>Why Join FalconPrime Insurance Services?<ul><li>Work in a structured and professional insurance environment</li><li>Gain hands-on experience in claims analysis and risk management</li><li>Opportunity to develop analytical and decision-making skills</li><li>Exposure to real-world insurance operations and compliance processes</li><li>Career growth opportunities within the insurance sector</li></ul>Work Setup &amp; Benefits<ul><li>Standard office working hours</li><li>Competitive salary (based on experience)</li><li>Health insurance and paid leave</li></ul>Job Types: Full-time, Contract, Permanent Contract length: 12 monthsPay: QAR270.00 per hourExpected hours: 20 per weekWork Location: In person

Claims Analyst

South Central Regional Medical Center

<div>Epic Billing Claims &amp; Electronic Remittance Analyst &ndash; Job Description
Position Summary
The Epic Billing Claims and Electronic Remittance Analyst is responsible for the design, build, optimization, and support of Epic Revenue Cycle functionality related to claims submission, remittance advice (ERA), and payer connectivity. This role partners closely with Revenue Cycle, Patient Financial Services, IT, and external payers to ensure accurate, timely billing and reimbursement while supporting continuous optimization and regulatory compliance.
Application Build &amp; Configuration<ul><li>
Configure, support, and optimize Epic Billing Claims, Electronic Remittance (ERA), and related Revenue Cycle workflows.</li><li>
Build and maintain claim formats, payer edits, remittance routing, adjustment reason codes and posting logic.</li><li>
Support clearinghouse integrations and payer connectivity.</li><li>
Configure and troubleshoot ANSI X12 transactions (837, 835, 276/277, 999).</li><li>
Maintain payers-specific rules, claim edits, and remittance mapping.</li></ul>
Claims &amp; Remittance Operations<ul><li>
Troubleshoot claim rejections, denials and remittance posting issues.</li><li>
Analyze payer responses and identify root causes of claim failures or posting discrepancies.</li><li>
Support electronic payment posting, secondary billing and reconciliation processes.</li><li>
Partner with billing and follow-up teams to improve first-pass claim acceptance and payment accuracy.</li></ul>
Optimization &amp; Reporting<ul><li>
Participate in optimization initiatives to improve claims throughput, reimbursement accuracy and cash flow.</li><li>
Analyze workflows and recommend system enhancements aligned with Epic best practices.</li><li>
Develop and maintain reports and dashboards related to claims status, remittance posting and payer performance.</li><li>
Support system upgrades, patches and new Epic functionality related to billing and remittance.</li></ul>
Collaboration &amp; Governance<ul><li>
Collaborate with operational stakeholders, payers, clearinghouses, and vendor partners.</li><li>
Participate in governance groups, optimization committees, and project workgroups.</li><li>
Assist with testing (unit, integrated, and user acceptance testing) for Revenue Cycle changes.</li><li>
Provide end-user training, documentation, and ongoing support.</li></ul>
Compliance &amp; Quality<ul><li>
Ensure Epic build and workflows comply with regulatory requirements (CMS, HIPAA, payer rules).</li><li>
Support audits related to billing, claims, and remittance processing.</li><li>
Follow change management and documentation standards.</li></ul>
Qualifications
Required<div><ul><li>
Bachelor&rsquo;s degree in Information Systems, Business, Healthcare Administration, or a related field; or equivalent experience.</li><li>
1&ndash;3+ years of Epic experience preferred (Hospital Billing, Professional Billings, Claims, and Remittance).</li><li>
Hands-on experience supporting revenue cycle with focus on claims and electronic remittance.</li><li>
Understanding of healthcare billing workflows and payer interactions.</li><li>
Knowledge of EDI transactions (837, 835) and remittance processes.</li></ul></div><ul><li>
Strong analytical, problem‑solving, and troubleshooting skills.</li><li>
Excellent communication and customer service abilities.</li></ul>
Preferred<ul><li>
Epic certification in Billing or willingness to obtain within 90 days.</li></ul>
Competencies<ul><li>
Ability to translate billing workflows into technical Epic configuration.</li><li>
Strong attention to detail and commitment to documentation accuracy.</li><li>
Ability to work both independently and collaboratively with clinical teams.</li><li>
Strong organization, time management, and prioritization skills in a fast‑paced environment.</li><li>
Discretion and ability to manage PHI and sensitive patient information.</li><li>
Experience with Epic Hyperspace, Reporting Workbench, SmartTools, or clinical decision support is a plus.</li></ul>
Work Environment<ul><li>
Standard office environment with hybrid or in‑office options based on organizational policy.</li><li>
Occasional after‑hours or on‑call support during upgrades, go‑lives, and critical clinical workflows.</li></ul></div>

BILLING CLAIMS & ELECTRONIC REMITTANCE ANALYST

NTT DATA

Req ID: 367045
 
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
 
We are currently seeking a Business Analysis Specialist Advisor to join our team in Dallas, Texas (US-TX), United States (US).
 
Job Title
 
Solution Business Analyst – Healthcare
 
Day to Day job Duties: (what this person will do on a daily/weekly basis)
 
Role Summary
 
We are seeking an experienced Solution Business Analyst (SBA) with deep Healthcare domain expertise and hands-on experience in AI-driven and Agentic solutions. The ideal candidate will act as a strategic bridge between business stakeholders, clinical users, engineering teams, and data science teams, translating healthcare problems into scalable AI-powered solutions.
 
The role focuses on designing and delivering AI Agent-based healthcare solutions such as intelligent virtual agents, clinical decision support, care coordination assistants, patient engagement bots, automation for claims and revenue cycle management, and operational optimization.
 
Key Responsibilities
 
Business Domain Analysis
 <ul>
<li>Engage with healthcare stakeholders (providers, payers, life sciences, operations, compliance, IT) to understand business needs, workflows, and pain points.</li>
<li>Analyze as-is and to-be healthcare workflows, including clinical, administrative, operational, and financial processes.</li>
<li>Identify opportunities where AI Agentic systems can improve outcomes, reduce costs, or enhance efficiency.</li>
</ul>
AI Solution Design Requirements
 <ul>
<li>Define business, functional, and non-functional requirements for AI-powered and agent-based solutions.</li>
<li>Collaborate with AI/ML, data engineering, and solution architecture teams to design:</li>
<li>Autonomous or semi-autonomous AI agents</li>
<li>Multi-agent workflows</li>
<li>Human-in-the-loop systems</li>
<li>Translate requirements into:</li>
<li>User stories / epics</li>
<li>Process flows</li>
<li>Decision logic</li>
<li>Agent orchestration diagrams</li>
</ul>
Healthcare AI Use Cases
 <ul>
<li>Support AI solutions across healthcare use cases such as:</li>
<li>Patient engagement virtual health assistants</li>
<li>Clinical decision support systems (CDSS)</li>
<li>Care management population health</li>
<li>Claims automation prior authorization</li>
<li>Revenue cycle management</li>
<li>Clinical documentation EHR automation</li>
<li>Ensure solutions align with clinical safety, quality, and usability standards.</li>
</ul>
Data, Compliance Governance
 <ul>
<li>Work with data teams to define data requirements, sources (EHR, HL7/FHIR, claims, IoT, labs), and quality metrics.</li>
<li>Ensure AI solutions comply with healthcare regulations and standards including:</li>
<li>HIPAA</li>
<li>GDPR (where applicable)</li>
<li>HL7 / FHIR</li>
<li>Clinical governance and audit requirements</li>
<li>Assist in defining explainability, auditability, and bias mitigation requirements for AI agents.</li>
</ul>
Stakeholder Delivery Management
 <ul>
<li>Serve as a trusted advisor to clients and internal stakeholders.</li>
<li>Facilitate workshops, requirement sessions, and solution walkthroughs.</li>
<li>Support Agile delivery by participating in:</li>
<li>Sprint planning</li>
<li>Backlog grooming</li>
<li>UAT coordination</li>
<li>Assist with solution documentation, demos, and go-live support.</li>
</ul>
Basic Qualifications: (what are the skills required to this job with minimum years of experience on each)
 
Required Skills Experience
 
Core Experience
 <ul>
<li>6+ years of experience as a Business Analyst / Solution Analyst in the Healthcare domain.</li>
<li>Strong understanding of healthcare ecosystems (providers, payers, life sciences, EHR systems).</li>
<li>Hands-on experience working on AI, ML, NLP, or automation-driven solutions.</li>
</ul>
AI Agentic Knowledge
 <ul>
<li>Understanding of:</li>
<li>AI Agents and Agentic workflows</li>
<li>LLM-based solutions (chatbots, copilots, virtual assistants)</li>
<li>Human-in-the-loop AI systems</li>
<li>Ability to translate business needs into AI agent behaviors, prompts, and workflows.</li>
<li>Familiarity with AI risks, ethics, and governance in healthcare.</li>
</ul>
Technical Analytical Skills
 <ul>
<li>Experience with:</li>
<li>Requirement modeling (BPMN, UML)</li>
<li>User stories and acceptance criteria</li>
<li>API-based and data-driven architectures</li>
<li>Working knowledge of:</li>
<li>EHR systems (Epic, Cerner, etc.)</li>
<li>HL7, FHIR standards</li>
<li>Cloud-based AI platforms (Azure, AWS, GCP – preferred)</li>
</ul>
Soft Skills
 <ul>
<li>Excellent stakeholder management and communication skills.</li>
<li>Ability to explain complex AI concepts to non-technical and clinical users.</li>
<li>Strong problem-solving and critical thinking mindset.</li>
<li>Collaborative and adaptable in fast-paced, innovation-driven environments.</li>
</ul>
Preferred Qualifications
 <ul>
<li>Experience delivering AI products or agent-based platforms in healthcare.</li>
<li>Exposure to GenAI, LLM orchestration frameworks, or autonomous agents.</li>
<li>Bachelor’s degree in Healthcare, IT, Engineering, or related field (Master’s preferred).</li>
<li>Certifications such as:</li>
<li>CBAP / CCBA</li>
<li>Healthcare IT certifications</li>
<li>Agile / Scrum BA certification</li>
</ul>
About NTT DATA
 
NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in RD.
 
Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.
 
NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.

Business Analysis Specialist Advisor

Harbor Claims LLC

<div>Description: Job Overview
Our Claims Analyst I&rsquo;s are our entry-level team members who are selected for, participate in and earn the opportunity to graduate from our Harbor Claims College. During Claims College, they are considered students and learn how to handle basic claims the Harbor Claims way in both a classroom and hands-on environment. After successful completion of Harbor Claims College, our Claims Analysts I initially focus their attention on providing constant, top-quality and highly-responsive service to our customers in order to successfully handle first notice of loss (FNOL) communications and or routine claims inquiries and/or issues from policyholders, agents and other Company team members. Concurrently, in order to expose the Claims Analyst I&rsquo;s to the &ldquo;nuts and bolts&rdquo; of the Harbor Claims way, our Claims Analyst I&rsquo;s provide other administrative and technical assistance in support of their team. Eventually, as their knowledge base expands, our Claims Analyst I&rsquo;s are tasked with handling routine claims files within minimum levels of authority and then receive increased exposure to more challenging files as they demonstrate mastery and ability. Our Claims Analyst I&rsquo;s have varied backgrounds, but all come to the job ready, willing and able to quickly and thoroughly learn the &ldquo;ins and outs&rdquo; of Cabrillo claims handling from their team leaders and specialists.
Job Responsibilities
Under close supervision, provides outstanding service to Harbor Claims external and internal customers; utilizes tact, diplomacy and professional communication skills to positively represent Harbor Claims in telephone and email contacts; per Company claims guidelines, Company quality and time standards and governmental regulations, appropriately and correctly responds via telephone and email interactions to claimants&rsquo;, agents&rsquo; and third party representatives&rsquo; routine claims, policy and other related inquiries and issues; handles first notice of loss communication and/or communicates with customers on assigned pending claims files on an ongoing basis.
Within minimum levels of authority and required time frames and with close supervision, assigns applicable claims to independent and/or Harbor Claims field adjusters; provides professional and responsive assistance on pending claims to independent and/or Harbor Claims field adjusters; develops and maintains effective working partnerships with independent and field adjusters to ensure prompt and appropriate claims&rsquo; actions.
Within minimum authority levels and time frames, with close supervision, and adeptly utilizing assigned tools, analyzes claims information to determine appropriate settlement; communicates with claimant regarding settlement; settles claim and closes files; when outside scope of authority, clearly communicates pertinent information regarding files and works with other assigned analysts and/or leaders to ensure prompt resolution of claims.
Maintains claims files in compliance with governmental regulations and Company standards; efficiently and effectively utilizes multiple Carrier and Harbor Claims Information Systems/Programs to accurately maintain Claims files and file diaries.
As requested by leaders and/or other analysts, assists in review of designated files for subrogation potential; as warranted, identifies potential subrogation opportunities; clearly communicates findings to leaders, other analysts and/or subrogation specialist and provides follow-up assistance and support, as necessary.
Actively contributes as a member of the Harbor Claims Team by providing assistance and support to assigned claims, underwriting, customer support, product, sales and/or other team members; as requested.
Participates in and/or assists with &ldquo;special&rdquo; Company projects, including CAT planning, organization, and preparation as directed.
Dynamically enhances Company&rsquo;s success by taking advantage of learning and development opportunities and personally integrating positive actions to improve individual performance.
Job Family Overview
Our Harbor Claims team provides direct, prompt, courteous and professional service to our policyholders, their agents, legal counsel and/or other third party representatives in the unfortunate event that the policyholders&rsquo; residential property is damaged or lost due to a covered event. To that end, our claims team members apply their technical know-how on a daily basis to review, investigate, evaluate and settle claims in a timely and equitable manner while also successfully and responsively handling claims inquiries and/or issues from many different people, including policyholders, agents, claimants&rsquo; third party representatives, as well as internal customers or carrier representatives, as assigned.
Most of our employees on our Harbor Claims team are in positions that are included in our claims analyst progressive job series, comprised of Claims Analyst I, II and III. By utilizing a progressive job series, our claims analysts are able to learn and consequently earn advancement on the claims team and in the Company. We provide clear criteria that defines what represents demonstrated mastery at each level. Once an incumbent has mastered that position in the progressive job series, he/she, with his/her claims team leader&rsquo;s active input and agreement, is eligible to advance to the next level in the series, increasing his/her responsibility, authority and pay levels as a result. At Harbor Claims, along with our claims analysts&rsquo; progressive job series, we also have a field adjusters&rsquo; job series. A claims analyst is differentiated from a field adjuster in that the claims analyst is our internal &ldquo;desk&rdquo; adjuster located at our headquarters office who might, depending on the type, severity and/or location of claim, request a field adjuster or an independent adjuster go out and investigate a claim on the Company&rsquo;s behalf while the field adjuster is out in the field on a day-to-day basis examining claims.
The other positions on our claims team include our claims team leaders and claims team specialists. These positions, respectively, are the supervisory and expert level positions on the team. Both types of positions require incumbents who are exceedingly well-versed in - and passionate about - their chosen profession of claims and additionally require incumbents with a remarkable understanding of, deep appreciation and respect for and ability to flourish in the Company&rsquo;s unique culture and work environment. Our claims team leaders serve a vital role in our Company&rsquo;s success by utilizing their demonstrated and dynamic leadership strengths to provide front-line day-to-day coaching, supervising &amp; leading of assigned claims analysts and/or field adjusters, while also continuing to carry out their respective day-to-day claims handling duties as working claims analysts. Comparable to our claims team leaders, our claims team specialists are also expected to carry out their assigned day-to-day claims handling or field adjusting duties as working claims analysts, while also continually demonstrating an exceptional depth and/or breadth of technical knowledge and claims expertise. Due to the breadth of their knowledge, they serve as the Go-To for the claims and customer support teams in those niche areas. Furthermore, as a result of the breadth of their knowledge, they are the team members who, at a moment&rsquo;s notice due to fluctuating business needs, can also be open, flexible, willing and adroitly able to take on additional pending and/or new claims files as needed. Our team specialists are expected to train team members on a recurring basis by teaching new hires how to do things our way (aka, the right way the first time), training current team members about new information and/or tasks and/or teaching multiple team members on a large-scale, even Company-wide, basis about a discipline in which the incumbent demonstrates proven expertise and knowledge. Finally, both our team leaders and specialists may spearhead a myriad of special projects producing important results and positive impact for the Company.
Requirements: Skills and Expertise
Qualities: quality- oriented; detail-oriented; self-starter; team player; multi-tasker; adaptability; flexibility; strong work ethic; positive &ldquo;can do&rdquo; attitude; collaborator; financially-oriented; service-oriented; coachable; dependable.
Strong skill sets in the following areas: effective decision-making; time management/working under tight deadlines; information and financial review and analyses; organization; problem analyses/solving; active listening; asking good questions to learn about claims handling; oral and written communication; interpersonal communication.
Strong knowledge of: business writing, grammar and punctuation rules; telephone and email business etiquette rules; desktop computer operations; standard business software and web-based engine operations (e.g., Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet Explorer). MS Access and MS PowerPoint a plus.
Licenses, Education and/or Experience
Bachelor&rsquo;s Degree or equivalent work experience. Insurance-related degree or residential property claims customer service experience is highly desirable. A current 6-20 adjuster license, other applicable states&rsquo; adjuster license/s and/or required obtainment of specified license/s within three months of hire, specific to the job opening, is required.</div>

Claims Analyst I/II (Residential Property)

CHRISTUS Health

<div>Description 
Summary:
Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as well as other operational departments to ensure validation and quality assurance of benefit, contract, reimbursement, and overall financial analysis that arise during the overpayment identification and recovery process.
Responsibilities:
<ul><li>Identify, analyze, and interpret trends or patterns in complex data sets.</li><li>
Leverages available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution; documents all activity in accordance with organization policies.</li><li>
Performs review of claim projects resulting from overpayments or underpayments related to benefits, contracts, and fee schedule defects.</li><li>
Performs root cause analysis and financial impacts of identified defective claims.</li><li>
Communicates findings, including trends and recommendations to appropriate leadership.</li><li>
Research, maintain, test, and create fee schedule tables from data obtained from CMS, Tricare (CHAMPUS), or custom rates into the claims system.</li><li>
Research, maintain, and create provider reimbursement contract configuration.</li><li>
Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals.</li><li>
Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).</li><li>
All other duties assigned by management.</li></ul>
Requirements:
Education/Skills
<ul><li>High school diploma or equivalent experience in healthcare claims adjudication, system configuration, and auditing</li><li>
Strong understanding of healthcare claims data, pricing, and claims editing concepts, including UB04 and HCFA 1500 claim content</li><li>
Strong working knowledge of health insurance concepts, practices, and procedures, including the understanding of provider payment methodologies and claims processing workflows, from receipt through final adjudication</li><li>
Strong analytical and research abilities to triage issues and perform reconciliations or data analysis</li><li>
Working knowledge of Federal and State regulatory rules regarding claims adjudication</li><li>
Ability to organize and prioritize work to meet deadlines</li><li>
Strong Microsoft Office application skills, including Microsoft Word and Excel (VLOOKUP, Pivot Tables, Index/Match, Formulas, and creating spreadsheets)</li><li>
Strong organizational skills and the ability to manage multiple competing projects and deadlines</li><li>
Ability to think creatively</li><li>
Excellent written and verbal communication skills</li><li>
Good judgment, initiative, and problem-solving abilities</li><li>
Ability to handle and resolve complex issues independently</li><li>
Knowledge of Commercial, Medicare Advantage, Tricare, and Health Care Exchange programs preferred</li><li>
Knowledge of CPT/HCPCS, ICD-10 coding, and medical terminology.</li><li>
Ability to learn new policies and processes based on written material and observation</li><li>
Ability to establish and maintain professional, positive, and effective work relationships</li><li>
Demonstrated ability to collaborate effectively and work as part of a team in a fast-changing environment</li></ul>
Experience
<ul><li>0&ndash;1 year of experience interpreting complex provider agreements, claims adjudication, system configuration, and auditing.</li></ul>
Work Schedule: 
MULTIPLE SHIFTS AVAILABLE
Work Type:
Full Time</div>

Payment Integrity Analyst I-HP Benefit Configuration

Search 10000+ Healthcare claims analyst jobs near you this May. New roles added regularly across leading industries. Apply today.