medical claims analyst

CES, LLC

<div><b>Job Description</b> <b>Summary:</b><br>
The Claims Analyst ensures the review and analysis of sampled Medicaid claims using associated medical records; makes payment determinations based on coverage, coding, utilization of services and practice guidelines; and makes medical necessity determinations utilizing clinical review judgment in accordance with the PERM Program policies and contract responsibilities. The period of performance for this role is from 12/1/2025-3/15/2026.<br>
<br>
<b>Duties/Responsibilities:</b><br>
<ul><li>Conducts in-depth claims analysis utilizing ICD-9-CM, ICD-10-CM, CPT-4, APR-DRG, and HCPCS Level II coding principles</li>
<li>Conducts medical record audits to determine the medical necessity and/or appropriateness of medical treatment as defined by the Statement of Work and CMS directives as well as State specific regulations pertaining to Medical necessity</li>
<li>Reviews the Master Policy List and the MR questionnaire and develops State Fact Sheets and Resource Page for each assigned State prior to the review of claims for that State</li>
<li>Functions as the policy and regulation expert in assigned states</li>
<li>Provides electronic documentation of findings and conclusions with determinations of claims payment appropriateness in review tool fields</li>
<li>Reviews and completes the required number of claims reviews in accordance to established production standards for the project</li>
<li>Communicates internally with all levels of PERM staff</li>
<li>Attend assigned State meetings</li>
<li>Participates in QA and IRR monitoring as requested</li>
<li>Complies with departmental policies and procedures</li>
<li>Comply with QA benchmarks established by the PERM MR department</li>
<li>Attends departmental and required education and training programs</li>
<li>Performs other projects or duties as assigned by the Senior Medical Review Specialist</li>
</ul>
<br>
<b>Required qualifications/skills:</b><br>
<ul><li>Graduate from an accredited Registered Nurse (RN) school (associate degree or diploma based) or Bachelor's Degree (preferred) with active state licensure in one or more of the 50 states or D.C.</li>
<li>Ability to comprehend medical policy and criteria to clearly articulate health information</li>
<li>Team-oriented and able to implement the operational strategies and procedures that will help achieve the overall quality and production goals of the Medical Review unit</li>
<li>Knowledge of ICD-10-CM and CPT-4 coding</li>
<li>Minimum three years of experience in a clinical setting with experience evaluating medical necessity of services, diagnosis and procedure coding and appropriateness of clinical settings.</li>
<li>Inpatient Interqual/Milliman screening or similar product experience preferred</li></ul></div>

Medical Claims Analyst (RN)

MaxRemind

<p><b>Job Title:</b> Medical Billing Specialist &amp; Reporting Analyst</p><p><b>Company:</b> MaxRemind</p><p><b>Job Description:</b><br/>MaxRemind is seeking a detail-oriented and dedicated <b>Medical Billing Specialist &amp; Reporting Analyst</b> to join our team. The ideal candidate will be responsible for ensuring the accurate preparation, submission, and reconciliation of medical claims, along with performing data analysis to support operational efficiency and reporting accuracy.</p><p><b>Key Responsibilities:</b></p><ul><li>Prepare, review, and submit medical claims to insurance companies accurately and within deadlines.</li><li>Monitor claim rejections and denials, identify root causes, and ensure timely resolution.</li><li>Post payments and reconcile accounts to ensure correct posting in the system.</li><li>Perform data analysis to identify trends and provide insights for process improvement.</li><li>Maintain confidentiality and ensure compliance with HIPAA and company policies.</li><li>Utilize EHR/PM systems and payer portals effectively.</li><li>Demonstrate strong analytical and communication skills.</li></ul><p><b>Qualifications:</b></p><ul><li>Bachelor&rsquo;s degree (Mandatory).</li><li>6 months&ndash;1.5 years of experience in US medical billing and reporting.</li></ul><p><b>Benefits:</b></p><ul><li>Competitive salary.</li><li>Lunch and tea provided.</li><li>Career growth opportunities.</li><li>Supportive and collaborative team environment.</li></ul><p><b>Location: </b>Near Old Airport, Fazal Town Phase 2, Rawalpindi.</p><p><b>Timings: </b>(Onsite) 8 AM - 5 PM</p><p><b>How to Apply:</b><br/>Interested candidates are encouraged to send their resumes to <b>hr@mremind.com</b></p><p>Job Type: Full-time</p><p>Pay: Rs40,000.00 - Rs50,000.00 per month</p><p>Work Location: In person</p>

Medical Billing Specialist and Reporting Analyst

CCMSI

<div>Overview:
<div><b>
Position Title:</b> Benefit Analyst<br>
<b>Location:</b> Metairie, LA<br>
<b>Work Arrangement:</b> In Office<br>
<b>Schedule:</b> Monday&ndash;Friday, 8:00 AM to 4:30 PM<br>
<b>Salary Range:</b> $19.00/hr-$23.00/hr</div><div></div><div><br>
At <b>CCMSI</b><b>, </b>we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.</div><div></div><div><b><br>
Reasons you should consider a career with CCMSI:</b></div><ul><li><ul><li><b>
Culture: </b>Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.</li><li><b>
Career development:</b> CCMSI offers robust internships and internal training programs for advancement within our organization.</li><li><b>
Benefits:</b> Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.</li><li><b>
Work Environment:</b> We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.</li></ul></li></ul><div></div><div><br>
The <b>Benefit Analyst</b> is responsible for the processing of medical, dental and prescription drug card claims for assigned accounts according to individual client contracts. Duties will include those items assigned from the following list: handling subrogation, checking and releasing &ldquo;hold&rdquo; claims, performing claim audits for the claims team, working with &ldquo;outside&rdquo; auditors and/or excess carriers on audits, trouble shooting for problems or issues that arise in the claims area.</div>
Responsibilities:
<ul><li>Interprets plan documents on policy or coverage questions or issues, resolves claims problems, review denials, subrogations or coordination of benefits with assistance from other staff or Medical Reviewer as needed.</li><li>
Proper and expeditious handling of medical, dental and prescription drug card claims processing and payment according to the assigned client&rsquo;s Schedule of Benefits and contract provisions.</li><li>
Work closely with the client&rsquo;s Plan Administrator or other designated individual(s) to resolve any claim problems related to the account, or provide needed information.</li><li>
Answer client questions, including but not limited to claims payment status and coverage information for assigned accounts.</li><li>
Upon receipt of claims, review and process, on computerized adjudication system, for payment under the client&rsquo;s Schedule of Benefits and contract.</li><li>
Other related duties include contacting client or health care providers for refunds on overpayments or errors on claims processed; entering of pertinent employee information for new accounts; insuring claims are processed within the policy year or run-out period for incurred/paid contracts.</li><li>
Following completion of the claims process/payment, all related paperwork to Support Services, unless the claim is a specific or hold claim.</li><li>
Performs other duties as assigned.</li></ul>
Qualifications:
<div>
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div><br>
<div></div><ul><li>
Excellent oral and written communication skills.
</li><li>Initiative to set and achieve performance goals.
</li><li>Good analytic and negotiation skills.
</li><li>Ability to cope with job pressures in a constantly changing environment.
</li><li>Knowledge of all lower level claim position responsibilities.
</li><li>Must be detail oriented and a self-starter with strong organizational abilities.
</li><li>Ability to coordinate and prioritize required.
</li><li>Flexibility, accuracy, initiative and the ability to work with minimum supervision.
</li><li>Discretion and confidentiality required.
</li><li>Reliable, predictable attendance within client service hours for the performance of this position.</li><li>
Responsive to internal and external client needs.</li><li>
Ability to clearly communicate verbally and/or in writing both internally and externally.</li></ul><div></div><div><b><br>
Education and/or Experience</b></div><div>
High school diploma or equivalent.</div><div>
3+ years claims experience.</div><div>
Medical terminology required.</div><div>
Prior experience in medical claims billing, payment and posting.</div><div></div><div><b><br>
Computer Skills</b></div><div>
Proficient with Microsoft Office programs.</div><div><br>
</div><div><b>Certificates, Licenses, Registrations
</b></div><div>None required.</div><div></div><div><b><br>
Physical Demands
</b></div><div>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div><ul><li>
Work requires the ability to sit or stand up to 7.5 or more hours at a time.</li><li>
Work requires sufficient auditory and visual acuity to interact with others.</li></ul><p><br>
</p><div><b>CORE VALUES &amp; PRINCIPLES
</b></div><div>Responsible for upholding the CCMSI Core Values &amp; Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.</div><div></div><div><b><i><br>
Compensation &amp; Compliance</i></b></div><div><i>
The posted salary reflects CCMSI&rsquo;s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity.</i></div><div></div><div><i><br>
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.</i></div><div></div><div><b><i><br>
Visa Sponsorship:</i></b></div><div><i>
CCMSI does not provide visa sponsorship for this position.</i></div><div></div><div><b><i><br>
ADA Accommodations:</i></b></div><div><i>
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.</i></div><div></div><div><b><i><br>
Equal Opportunity Employer:</i></b></div><div><i>
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.</i></div><div></div><div><b><i><br>
#benefitanalyst #InsuranceCareers #GreatPlaceToWorkCertified #EmployeeOwned #CCMSICareers #NowHiring #IND456 #LI-Hybrid</i></b></div></div>

Benefit Analyst

Alliance Insurance Abu Dhabi

<b>Responsibilities</b>: <br><p>Receive, review, and process medical insurance claims submitted by policyholders or healthcare providers.</p>
<p>Adjudicate claims based on policy terms, coverage limits, and medical necessity criteria.</p>
<p>Verify the accuracy and completeness of claim forms, medical records, and supporting documentation.</p>
<p>Investigate questionable claims by contacting healthcare providers, requesting additional information or documentation, and analysing medical records.</p>
<p>Make decisions on claim approvals, denials, or requests for additional information based on investigation findings and policy guidelines.</p>
<p>Ensure timely and accurate processing of approved claims for payment, including coordinating with finance departments and third-party administrators.</p>
<p>Communicate with policyholders, healthcare providers, and internal stakeholders regarding claim status, decisions, and any required actions.</p>
<p>Maintain detailed records of claims, correspondence, and investigation outcomes in accordance with regulatory requirements and company policies.</p>
<p>Ensure compliance with healthcare regulations, coding standards (e.g., ICD-10, CPT), and company policies throughout the claims process.</p>
<p>Provide excellent customer service to policyholders and healthcare providers, addressing inquiries and resolving <b>issues related to claims.</b></p><b>
 Qualification &amp; Skills: </b><br><ul>
<li>Bachelor of Medicine, Bachelor of Surgery (MBBS), Nursing degree, or relevant medical degree from an accredited institution.</li>
<li>Experience in the relevant health insurance industry is preferred.</li>
<li>Minimum knowledge of computer skills, including proficiency in Excel and other relevant software applications.</li>
<li>Strong analytical, communication, and problem-solving skills.</li>
<li>Attention to detail and ability to work efficiently in a fast-paced environment.</li>
<li>Ability to prioritize tasks and meet deadlines effectively.</li></ul>

Senior claims officer

Hiffey

<p>Claims Med pioneers in Medical Billing for Healthcare providers in the United States. We are looking for fresh, energetic individuals who can not only add value to our firm, but also find endless opportunities in a growing firm.<br/>We are currently hiring for our Medical billing/AR/Credentialing teams and looking for candidates who are willing to learn and apply themselves in a short period of time.<br/>Job Description</p><ul><li>Medical records evaluation</li><li>Insurance eligibility verification</li><li>Claim generation and submission</li><li>Follow-up on pending claims</li><li>Account Receivables</li></ul><p>Requirements</p><ul><li>Night shift availability (7pm to 4am)</li><li>Mondays to Fridays</li><li>Graduation (required)</li><li><b>English Proficiency is must</b></li></ul><p>Location<br/>Shaheed-e-Millat Rd, Karachi<br/>Paid training will be provided. Finalists will begin a 3-month probation period and will be re-evaluated before becoming permanent employees.<br/>Permanent employees enjoy several performance, and punctuality based bonuses, along with other perks.<br/>Please submit your resumes and begin your journey of becoming an integral part of the Claims Med family.</p><p>Job Type: Full-time</p><p>Pay: Rs45,000.00 - Rs50,000.00 per month</p><p>Work Location: In person</p>

Medical Billing Analyst(Male)

WHEALTH INTERNATIONAL L.L.C

<ul><li>Analyze medical claims for accuracy, ensuring all details align with provided documentation and coding guidelines.</li><li>Investigate and resolve claim discrepancies, contacting providers and patients to gather necessary information and clarify issues.</li><li>Process claims efficiently using specialized software, meeting daily processing targets and maintaining a high level of accuracy.</li><li>Verify patient eligibility for benefits, confirming coverage details and communicating any limitations to relevant parties.</li></ul>

Medical Claims Processor

Allianz

SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends cal SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends calls and e-mails from insurance companies, clients, and providers.   Coordinates with international providers for direct billing.   Makes suggestions to improve service.   Increases efficiency, minimizes errors and administration time. BEHAVIORAL REQUIREMENTS   Organizational &amp; time management skills.   Excellent team player.   Ability to work well with all levels of internal management and staff, as well as outside clients and users.   Ability to demonstrate sound work ethics.   Show flexibility with excellent interpersonal skills.   The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.   To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.   The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.   Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others. BEHAVIORAL COMPETENCY Customer &amp; Market Excellence:   Strive for excellence at every touch point with the customer   Foster state-of-art technical/operational knowledge and strive for continuous simplification   Be the benchmark Collaborative Leadership:   Empower the team and provide purpose and direction   Develop people, provide feedback and care to employee wellbeing   Collaborate and exchange best practice. Entrepreneurship:   Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure   Take ownership and responsibility   Embrace innovation and a culture that allows to make decisions without fear of retribution. Trust:   Act with integrity, honor commitments, tell the truth   Foster diversity and inclusiveness   Act transparently and promote corporate social responsibility. MINIMUM REQUIREMENTS   Bachelor's of Medicine (MBBS) only.   Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).   Physically fit to carry out duties.   Legally permitted to work in the country of operations.   Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills 44265 | Operations | Professional | ((custPositionClusterCSB)) | Allianz Partners | Full-Time | Permanent Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Great to have you on board. Let's care for tomorrow.

Medical Claims Officer

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