insurance claims analyst

NeighborHealth

<div><div><p><b>Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center!</b></p><p></p><p>
As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities.</p></div><p></p><div><p>
Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly &mdash; every role at NeighborHealth is vital. Together, we&rsquo;re advancing medicine and delivering the best care experience for our patients and community!</p></div><p></p><div><div><div><p>
Interested in this position? Apply online and create a personal candidate account!</p></div></div></div><p></p><p><b>
Current Employees of </b><b>NeighborHealth</b>- Please use our internal careers portal to apply for positions.</p><p></p><p>
To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page.</p><p></p><p><b>
Time Type:
</b></p>Full time<p></p><p><b>
Department:
</b></p>PACE Health Plan Management<p></p><p><b>
All Locations:
</b></p>300 Ocean Avenue &ndash; Revere<p></p><p><b>
Position Summary:
</b></p>Position Summary:
<br>
The Claims Analyst, under the direction of the Manager of PACE Claims, is responsible for the overall claims adjudication and insurance validation process. This includes:<div>
Claims Department:<br>
<ul><li>Maintaining up-to-date knowledge of fee schedules for both Medicare and MassHealth.</li><li>Ensuring the fee schedules are updated and are priced correctly in the Tapestry module.</li><li>Auditing adjudicated claims to ensure payments are made in accordance with their contracts.</li><li>Analyzing claims data to ensure accruals are reported to Finance in a timely and accurate manner.</li><li>Ensuring accuracy of claims-related cost reports.</li><li>Analyzing claims data for trends (e.g., referral matching).</li><li>Reporting any findings to PACE leadership.</li><li>Coordinating with IT to enhance and refine the claims adjudication process.</li><li>Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to provide utilization reports to other departments.</li></ul></div><div>
Insurance Department:<br>
<ul><li>Must maintain up-to-date knowledge of Coordination of Benefits.</li><li>In conjunction with the Supervisor of Business Services, responsible for assisting with and developing workflows to maintain overall compliance of the Insurance Department.</li></ul></div><p>
Schedule: Monday - Friday 8:00am - 5:00pm</p><p><b>
Insurance Department</b></p><ul><li>
Serves as the department Medicare expert. This includes auditing enrollment files to ensure compliance with the Part D requirements: EOBs, COB follow-up is completed timely and accurately, as well as documentation in EPIC regarding MSP surveys and TrOOP.</li><li>
Ensures primary insurance coverage is documented in EPIC and that insurance billing is appropriate.</li><li>
Responsible for the timely completion and documentation of CMS Part D reports: COB, MSP.</li><li>
Serves as back-up for Business Services Supervisor.</li></ul><p><b>
Expense Management/Claims</b></p><ul><li>
Monitors monthly expense reports to ensure that all expenses are correctly categorized and reported.</li><li>
Oversees the referral authorization process as it relates to timely and accurate claims payment and improvements to utilization management.</li><li>
Responsible for maintaining up-to-date knowledge of fee schedules and works with IT to ensure timely upload into Tapestry.</li><li>
Coordinates with the Manager of PACE Claims in an effort to improve the processes to manage claims payment and expenses based on trends analysis.</li><li>
Acts as the department claims expert regarding adjudication.</li><li>
Audits claims work queues to ensure timely and appropriate payment to vendors; suggests process improvements (e.g., referral matching table edits).</li><li>
Coordinates with Finance to ensure appropriate accruals on a monthly basis. Reviews IBNR data with Finance in an effort to ensure all claims are received.</li><li>
Works closely with the Contracts Department to review reimbursement.</li></ul><p><b>
Information Technology</b></p><ul><li>
Serves as a liaison with IT, specifically regarding Tapestry (fee schedule development, claims processing, referrals) and reports and workflows related to ESP (Elder Service Plan) Business Office processes.</li></ul><p><b>
Other Duties</b></p><ul><li>
Regularly reports to work on time and follows attendance and call-in procedures.</li><li>
Works cooperatively and respectfully with others at all levels of the organization.</li><li>
Takes the initiative to perform a wide variety of activities and be flexible in terms of work assignments based on operational needs, contributing to the smooth functioning of the department.</li><li>
Displays outstanding customer service skills when interacting with all NH customers according to the PACE model.</li><li>
Creates and/or revises policies and procedures, workflows, and guidelines, as appropriate, in any respective areas under the Business Office or as requested by Manager.</li><li>
Other duties as required.</li></ul><p><b>
PACE AND GENERAL REQUIREMENTS: KNOWLEDGE, SKILLS AND ATTITUDES</b> (This section not applicable to initial assessment; all ESP employees and contractors attain these competencies through participation in PACE and TJC orientation programs.)</p><ul><li>
Demonstrates commitment to the PACE mission by actively promoting the autonomy and dignity of PACE program participants.</li><li>
Demonstrates commitment to a holistic approach to care by actively engaging in interdisciplinary team planning and communication processes.</li><li>
Demonstrates commitment to participant-centered care by actively engaging participants and/or Health Care Proxies in discussion about self-management goals.</li><li>
Understands ESP&rsquo;s organizational structure. Actively participates in NH programs and committees.</li><li>
Demonstrates the ability to communicate effectively and respectfully through verbal and written skills. Documents in accordance with protocol.</li><li>
Demonstrates knowledge of Participant Rights by:</li><li>
actively protecting rights to privacy;</li><li>
always treating participants with respect;</li><li>
encouraging and assisting participants in filing of complaints and grievances;</li><li>
helping to maintain a clean and safe environment;</li><li>
helping to ensure that restraint and involuntary seclusion are never used as a means of coercion, discipline, punishment, retaliation, or for the convenience of staff; and that those restraints, when required by extraordinary circumstance, are always applied and monitored in accordance with policy/procedure.</li><li>
Promotes a sense of &ldquo;teamwork&rdquo; through demonstration of self-direction and self-motivation. Solves problems independently or knows when to seek consultation. Provides leadership to other support staff on the practice team. Works cooperatively and respectfully with others at all levels of the organization.</li><li>
All ESP employees participate in the orientation, training, and mentoring of new employees and in providing input for continuous improvement.</li><li>
Displays outstanding customer service skills when interacting with ESP participants, family members, outside providers, potential ESP members, referral sources, or others.</li><li>
Interacts with participants in a professional and respectful manner that reflects the needs and concerns of the individual. Maintains a positive attitude. Uses communication devices appropriately.</li><li>
Demonstrates commitment to performance improvement by reporting incidents and other data used in ESP Performance Improvement activities, and by actively participating in one or more performance improvement committees or making a minimum of two suggestions for program or other improvements over the course of the year.</li><li>
Responsible for continued professional growth and development.</li></ul><p><b>
Pay Range: </b>Starting at $26/hr up to $39/hr based on experience</p><p><b>
EEO &amp; Accommodation Statement:</b></p><p>
NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@NeighborHealth.com or call 617-568-4480 to let us know the nature of your request</p><p><b>
Federal Trade Commission Statement:</b><br>
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or &ldquo;apps.&rdquo; Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.</p><p><b>
E-Verify Program Participation Statement:</b></p><p>
NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.</p></div>

Analyst, Claims

Accenture

<p><b>Skill required:</b> Life &amp; Annuity - Claims Processing<br>
<b>Designation:</b> Customer Service Analyst<br>
<b>Qualifications:</b>Any Graduation
<br>
<b>Years of Experience:</b>3 to 5 years
<br>
<b>About Accenture</b><br>
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song&mdash; all powered by the world&rsquo;s largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
<br>
<b>What would you do?</b> Responsible for Pre-screening, Data Entry, Receipting and Following-up of requirements for a Life Insurance Policy. Performs business processing transactions related to Life Insurance Policy Issuance. Responsible for checking the accuracy and completeness of the policy information based on predefined quality review checkpoints and guidelines. May make a few outbound calls per day or send out emails to an AIG department, a Brokerage Agency, business entity or customer to inquire about or gather information to complete a business transaction. What are we looking for Life &amp; Annuity Specialist is responsible for managing and administering life insurance policies and annuity contracts throughout their lifecycle. This role encompasses policy issuance, claims processing, and providing excellent customer service to policyholders. The primary goal is to ensure clients receive their entitled benefits and fully understand their coverage options Roles and Responsibilities &acirc;&euro;&cent; Process policy issuance and endorsements accurately and timely. &acirc;&euro;&cent; Manage life insurance and annuity claims, ensuring thorough review and prompt payouts. &acirc;&euro;&cent; Serve as a point of contact for policyholders, addressing inquiries and providing guidance on products and benefits. &acirc;&euro;&cent; Ensure all activities comply with regulatory requirements and company policies. &acirc;&euro;&cent; Maintain detailed and organized records of policy transactions and communications. &acirc;&euro;&cent; Collaborate with underwriting, sales, and claims teams to support client needs and resolve issues. &acirc;&euro;&cent; Stay updated on industry trends, product knowledge, and regulatory changes to maintain expertise Ability to efficiently and accurately handle insurance claims or other types of claims in various industries. Typically includes understanding relevant policies and procedures, verifying information, assessing claims for validity, and ensuring compliance with regulations.<br>
<b>What are we looking for?</b> &quot;College graduate or undergraduate with a minimum of 12 months experience in a related field Ability to multi-task and can easily learn and adapt with changes in a fast paced environment. Proficient in MS Office applications like Word and Excel. Good written and verbal communication skills.&quot; &quot;College graduate or undergraduate with a minimum of 12 months experience in a related field Ability to multi-task and can easily learn and adapt with changes in a fast paced environment. Proficient in MS Office applications like Word and Excel. Good written and verbal communication skills.&quot;
<br>
<b>Roles and Responsibilities:</b> &quot;Responsible for Pre-screening, Data Entry, Receipting and Following-up of requirements for a Life Insurance Policy. Performs business processing transactions related to Life Insurance Policy Issuance. Responsible for checking the accuracy and completeness of the policy information based on predefined quality review checkpoints and guidelines. May make a few outbound calls per day or send out emails to an AIG department, a Brokerage Agency, business entity or customer to inquire about or gather information to complete a business transaction.&quot;</p>
<br>
Any Graduation

Customer Service Analyst

RiseIT Solutions

<div><div><b>Title: Epic Claims Analyst</b></div>
<div>Location: 100% Remote</div>
<div>Type: Contract</div>
<div>Rate: DOE</div>
<div>Education: College Bachelors + Certifications</div>
<div></div><div>The Epic Claims Analyst is responsible for establishing credibility at all levels and builds problem-solving partnerships with customers and colleagues. The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive information systems. Documents workflows, system configuration, and change control documentation.</div>
<div></div><div>Confers with professional staff to ascertain specific requirements and assists in the completion of programming specifications. This requires the individual to stay current with the system and/or application as well as interfacing with the appropriate department and external analysts. Must employ excellent communication skills in sharing information with users within the department.</div>
<div></div><div>Qualifications</div>
<div></div><div>Minimum Education &amp; Experience:</div>
<ul><li>An approved equivalent combination of education and experience.</li></ul>
<ul><li>Healthcare Experience preferred.</li></ul>
<div>o Level 1 Not EPIC certified and less than 2 years experience</div>
<div>o Level 2 EPIC certified and 2 plus years experience</div>
<div>o Level 3 EPIC certified and 5 plus years experience</div>
<div></div><div>Required Certification/Registration:</div>
<ul><li>Epic Reimbursement and Contract Management.</li></ul>
<div></div><div>Skills and Abilities Required:</div>
<ul><li>Proficiency in more than two computer environments or platforms.</li></ul>
<ul><li>Ability to work with a computer terminal for extended periods of time.</li></ul>
<ul><li>Ability to handle multiple projects.</li></ul>
<ul><li>Ability to handle stressful situations.</li></ul>
<ul><li>Ability to work independently with little supervision</li></ul>
<ul><li>Ability to solve problems</li></ul>
<ul><li>Excellent technical aptitude</li></ul>
<ul><li>Excellent interpersonal skills</li></ul>
<ul><li>Excellent organizational skills</li></ul>
<ul><li>Excellent training skills</li></ul>
<ul><li>Flexible and effective in a team environment</li></ul></div><div></div>

Epic Claims Analyst

Anderson Hospital

<div><p><b>Job Summary</b><b>: Bills Auto, Attorney and Personal Injury cases, as well as Workers Compensation claims. Reviews and analyzes unpaid claims, determining action steps for follow-up and claim resolution. Is main point of contact for attorneys, accident adjusters, workers compensation adjusters, and accident/workers compensation patients. Is consultant to Patient Account Analyst for accident-related and workers compensation related credit balances. Is consultant to billing teams for health insurance claims for accident-related and workers compensation accounts.</b></p><p>
</p><p><b>Job Responsibilities:</b></p><ul><li><b>
Contacts patients after accident services for possible auto or personal injury no fault or liability insurance sources.</b></li><li><b>
Bills claims for auto, attorney , personal injury cases, and workers compensation.
</b></li><li><b>Bills claims accurately and in compliance with government and other payor regulations and guidelines.</b></li><li><b>
Liaison to PFS Director in lien processing and settlement requests.</b></li><li><b>
Prepares attorney requests for itemized billing and files liens as appropriate. Handles all attorney related correspondence and calls.</b></li><li><b>
Completes needed follow-up, working to manage outstanding Accident and Workers Compensation AR.</b></li><li><b>
Works with third party attorney for complex cases.</b></li><li><b>
Other duties as assigned.</b></li><li><b>
Identifies and recommends opportunities for process improvement in Patient Financial Services, or other Revenue Cycle departments, as related to the PFS processes.</b></li></ul><p><b>
Education Requirements and Other Requirements:</b></p><p>
Education Level: High school diploma or equivalent.</p><p>
At least 3 years experience with working with Accident and Workers Compensation claims.</p></div>

BILLER AND ANALYST,ACCIDENT AND WORKERS COMPENSATION - PATIENT FINANCIAL SERVICES - FT DAYS

Pinnacle Alliances

<p><b>Legal Invoice Analyst</b></p><p><b>Hybrid in Minneapolis, MN or Glastonbury CT</b></p><p><b>6+ Months</b></p><p><b>PR:$31/hr on W2</b></p><p>Requirements (years of experience, educational background, technical skills, etc.):</p><p>Education and Licensure Minimum: Bachelor&rsquo;s Degree required. Juris Doctor degree from an ABA-accredited law school required. Experience, Knowledge and Tools Required Experience: 0-2 years of the following experience.</p><ul><li>Prior experience in a legal services or legal invoice auditing environment.</li></ul><ul><li>Prior experience with direct communication with law firms in a legal billing context.</li></ul><ul><li>Experience with handling conflict with law firms, in writing and telephonically.</li></ul><ul><li>Highly developed communication skills, including both excellent written and verbal skills.</li></ul><ul><li>Firm grasp of the Federal and/or State Rules of Civil Procedure.</li></ul><ul><li>Insurance defense and civil litigation experience preferred.</li></ul><ul><li>Prior legal invoice auditing experience either in-house or with a third party legal invoice auditing company strongly preferred.</li></ul><p>Preferred Experience:</p><ul><li>Prior US and International legal invoice review and analysis experience in a legal invoice analyst role.</li></ul><ul><li>Prior experience in auditing claims litigation.</li></ul><ul><li>Prior work experience with an insurance company.</li></ul><ul><li>Experience in handling appeals of legal invoice claims adjustments.</li></ul><ul><li>Prior experience with direct communication with law firms in a legal invoice review context.</li></ul><ul><li>Experience with handling conflict with law firms, in writing and telephonically.</li></ul><ul><li>Highly developed communication skills, including both excellent written and verbal skills.</li></ul><p>Job Type: Contract</p><p>Pay: $30.00 - $31.00 per hour</p><p>Application Question(s):</p><ul><li>Juris Doctor</li></ul><p>Education:</p><ul><li>Bachelor's (Preferred)</li></ul><p>Experience:</p><ul><li>Legal Invoice: 2 years (Preferred)</li><li>Legal Billing: 2 years (Preferred)</li></ul><p>Location:</p><ul><li>Minneapolis, MN (Preferred)</li></ul><p>Work Location: In person</p>

Legal Analyst/Attorney

Forrest T Jones & Company

<p><b>Position Summary</b></p><p>Responsible for the following regulatory and compliance issues and support:</p><p>Legislative Review: Assist with monitoring and analysis of new laws and regulations. Areas of regulatory review may include rate and form filing requirements, health insurance mandated benefits, Guaranty Association notices, fraud, claims practices, escheat, same sex and non-discrimination laws, privacy, life and health insurance replacement, Annuity suitability, Anti-money Laundering, Advertising requirements, underwriting restrictions, and periodic reporting.</p><p>Compliance Procedures and Communication updates: Assist with identifying and incorporating needed updates to the Company&rsquo;s various Standard Practice Memorandum (SPMs) and Third-Party Administrator Compliance Bulletins.</p><p>Advertising Review and Compliance: Assist with the review and tracking of all life and health insurance advertising generated internally and by outside marketers.</p><p><b>Expectations</b></p><ul><li>Assist Senior Counsel with the monitoring and analysis of new laws and regulations that impact existing and new life and supplemental health insurance products</li><li>Areas of regulatory review may include rate and form filing requirements, health insurance mandated benefits, Guaranty Association notices, fraud, claims practices, escheat, same sex and non-discrimination laws, privacy, life and health insurance replacement, Annuity suitability, Anti-money Laundering, Advertising requirements, underwriting restrictions, periodic reporting and other topics as assigned.</li><li>Assist Senior Compliance Analyst with ongoing monitoring and updates to the Company&rsquo;s various SPMs and Compliance Bulletins.</li><li>Assist Senior Compliance Analyst with the review and tracking of all life and health insurance advertising generated internally and by outside marketers.</li><li>Performs miscellaneous research of compliance issues.</li><li>Performs other related duties as required and assigned.</li></ul><p><b>Competencies</b></p><ul><li>Superior oral and written communication skills to successfully interact with internal and external contacts at all levels</li><li>Ability to coordinate projects among multiple departments and clients</li><li>Detail oriented, ability to prioritize, self-starter, and capable of working independently</li><li>Ability to function at a high level in a fast-paced environment with changing priorities and willing to work beyond normal business hours when needed</li></ul><p>Requisites</p><ul><li>Bachelor&rsquo;s Degree preferred</li><li>5-10 years&rsquo; experience with life and supplemental health insurance products</li><li>Solid understanding of group and individual insurance policy form requirements and state insurance department requirements</li><li>Previous experience in reviewing life and health insurance product advertising a plus</li><li>Successful completion of insurance industry courses such as Life Office Management Association (LOMA) a plus</li></ul><p>We offer comprehensive benefits to full time employees including company paid medical, STD, LTD and life insurance; plus voluntary dental, vision, Life/AD&amp;D insurance, 401(k) with company-matching, generous paid time off and much more.</p><p>We encourage applicants of all ages and experience, as we do not discriminate on the basis of an applicant&rsquo;s age.</p><p>ALL OFFERS OF EMPLOYMENT ARE CONTINGENT UPON PASSAGE OF A DRUG SCREEN AND BACKGROUND CHECK.</p><p>Job Type: Full-time</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Paid time off</li><li>Referral program</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>FDA regulations: 1 year (Preferred)</li></ul><p>Work Location: In person</p>

Regulatory Compliance Analyst

<p><b>Skill required:</b> Property &amp; Casualty- Underwriting - Insurance Underwriting<br>
<b>Designation:</b> Underwriting Analyst<br>
<b>Qualifications:</b>Any Graduation
<br>
<b>Years of Experience:</b>3 to 5 years
<br>
<b>About Accenture</b><br>
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song&mdash; all powered by the world&rsquo;s largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
<br>
<b>What would you do?</b> We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment. You would be part of General Insurance team, where would you be managing, Claims Adjudication, Claims Processing /Portfolio Management. Checking on Fraudulent Claims Rating and quoting including receipt, clearance, data gathering and submission for operation of insurance services to set-up new business or renewal submissions in the support of developing an insurance quote.<br>
<b>What are we looking for?</b> Experienced Insurance professional with expertise in UA P&amp;C. Good Communication skills. Domain Certified: AINS, CPCU
<br>
<b>Roles and Responsibilities:</b> &bull;In this role you are required to do analysis and solving of lower-complexity problems &bull; Your day to day interaction is with peers within Accenture before updating supervisors &bull; In this role you may have limited exposure with clients and/or Accenture management &bull; You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments &bull; The decisions you make impact your own work and may impact the work of others &bull; You will be an individual contributor as a part of a team, with a focused scope of work &bull; Please note that this role may require you to work in rotational shifts</p>
<br>
Any Graduation

Underwriting Analyst

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