medical claims analyst

Med-Metrix

Job Purpose
 The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.
 
Duties and Responsibilities
 <ul>
<li>Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites</li>
<li>Meets and maintains daily productivity/quality standards established in departmental policies</li>
<li>Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts</li>
<li>Adheres to the policies and procedures established for the client/team</li>
<li>Knowledge of timely filing deadlines for each designated payer</li>
<li>Performs research regarding payer specific billing guidelines as needed</li>
<li>Ability to analyze, identify and resolve issues causing payer payment delays</li>
<li>Ability to analyze, identify and trend claims issues to proactively reduce denials</li>
<li>Communicates to management any issues and/or trends identified</li>
<li>Initiate appeals when necessary</li>
<li>Ability to identify and correct medical billing errors</li>
<li>Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process</li>
<li>Understanding of under or over payments and credit balance processes</li>
<li>Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required</li>
<li>Act cooperatively and courteously with patients, visitors, co-workers, management and clients</li>
<li>Work independently from assigned work queues</li>
<li>Maintain confidentiality at all times</li>
<li>Maintain a professional attitude</li>
<li>Other duties as assigned by the management team</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 <ul>
<li>Completed at least High School education</li>
<li>Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)</li>
<li>Experienced on medical billing/ AR Collections</li>
<li>Background in calling insurance (Payer) to verify claim status and payment dispute</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
<li>Gracious and welcoming personality for customer service interaction</li>
</ul>
Working Conditions
 <ul>
<li>Must be amenable to work night shifts</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Medical Claims Analyst

Alliance Insurance Abu Dhabi

Responsibilities: Receive, review, and process medical insurance claims submitted by policyholders or healthcare providers.
Adjudicate claims based on policy terms, coverage limits, and medical necessity criteria.
Verify the accuracy and completeness of claim forms, medical records, and supporting documentation.
Investigate questionable claims by contacting healthcare providers, requesting additional information or documentation, and analysing medical records.
Make decisions on claim approvals, denials, or requests for additional information based on investigation findings and policy guidelines.
Ensure timely and accurate processing of approved claims for payment, including coordinating with finance departments and third-party administrators.
Communicate with policyholders, healthcare providers, and internal stakeholders regarding claim status, decisions, and any required actions.
Maintain detailed records of claims, correspondence, and investigation outcomes in accordance with regulatory requirements and company policies.
Ensure compliance with healthcare regulations, coding standards (e.g., ICD-10, CPT), and company policies throughout the claims process.
Provide excellent customer service to policyholders and healthcare providers, addressing inquiries and resolving issues related to claims.
 Qualification &amp; Skills: <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

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. 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. Job Description<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>Requirements<ul><li>Night shift availability (7pm to 4am)</li><li>Mondays to Fridays</li><li>Graduation (required)</li><li>English Proficiency is must</li></ul>Location Shaheed-e-Millat Rd, Karachi Paid training will be provided. Finalists will begin a 3-month probation period and will be re-evaluated before becoming permanent employees. Permanent employees enjoy several performance, and punctuality based bonuses, along with other perks. Please submit your resumes and begin your journey of becoming an integral part of the Claims Med family.Job Type: Full-timePay: Rs45,000.00 - Rs50,000.00 per monthWork Location: In person

Medical Billing Analyst(Male)

Allianz

Key responsibilities/What you do: <ul> <li>Review and assess medical claims for both inpatient and outpatient services to determine coverage eligibility and compliance with policy terms.</li> <li>Validate Diagnosis-Related Group (DRG) coding for inpatient admissions using ICD-10-CM and CPT standards, ensuring alignment with clinical documentation.</li> <li>Apply thorough knowledge of UAE healthcare billing regulations, including DHA, DOH, and MOH guidelines, to ensure claims meet local compliance standards.</li> <li>Identify and rectify incomplete or inaccurate claim submissions.</li> <li>Ensure all required documentation is present and properly coded aligning with policy guidelines.</li> <li>Notify payers regarding claims that exceed predefined financial thresholds, ensuring timely communication and resolution.</li> <li>Track and maintain both quantitative (volume) and qualitative (accuracy) metrics for claims processing.</li> <li>Achieve assigned daily processing targets while maintaining high levels of accuracy and efficiency.</li> <li>Collaborate with internal departments to resolve claim-related queries.</li> <li>Perform other responsibilities as assigned by the department lead, in line with the scope of the role.</li> </ul>

Medical Claims Senior Assessor

Allianz Partners

Key Responsibilities/What You DoReview and assess medical claims for both inpatient and outpatient services to determine coverage eligibility and compliance with policy terms.Validate Diagnosis-Related Group (DRG) coding for inpatient admissions using ICD-10-CM and CPT standards, ensuring alignment with clinical documentation.Apply thorough knowledge of UAE healthcare billing regulations, including DHA, DOH, and MOH guidelines, to ensure claims meet local compliance standards.Identify and rectify incomplete or inaccurate claim submissions. Ensure all required documentation is present and properly coded aligning with policy guidelines.Notify payers regarding claims that exceed predefined financial thresholds, ensuring timely communication and resolution.Track and maintain both quantitative (volume) and qualitative (accuracy) metrics for claims processing.Achieve assigned daily processing targets while maintaining high levels of accuracy and efficiency.Collaborate with internal departments to resolve claim-related queries.Perform other responsibilities as assigned by the department lead, in line with the scope of the role.Key Benefits/What We OfferOur employees play an integral part in our success as a business. We appreciate that each of our employees are unique and have unique needs, ambitions and we enjoy being a part of their journey.We are there to empower and encourage you with your personal and professional development ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged. Caring for your health and wellbeing is key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.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.

Plymouth Rock Assurance

<div>In this vital role, the Medical Claims Litigation Representative is responsible for the management of arbitrations and lawsuits resulting from the processing of Personal Injury Protection and Extended Medical Expense Claims. These cases are handled in accordance to state compliance requirements and guidelines.

RESPONSIBILITIES

The ideal candidate for this position must have functional knowledge of medical terminology and anatomy with a thorough understanding of NY/NJ Personal Injury and Protection claim handling regulatory requirements as well as a functional knowledge of the NY/NJ Arbitration and Court Systems.
<ul><li>Must be able to investigate, perform analysis and negotiate Personal Injury related settlements with attorneys.</li>
<li>Ability to identify litigation trends and suggest alternative defenses.</li>
<li>The candidate must have the ability to outline mitigating points to prepare cases for a defense and manage the litigation process with both House Counsel and Outside Counsel.</li>
<li>Ability to participate and organize settlement conferences and projects utilizing the PIP Evaluator Data Base and mining data within Excel.</li>
<li>Excellent verbal and written communication skills are essential.</li>
<li>Strong organizational, computer and interpersonal skills are required.</li>
<li>The selected candidate must be able to manage multiple tasks including time sensitive issues.</li>
</ul>
QUALIFICATIONS
<ul>
<li>A Bachelor's Degree (B.A.) from a four year college or university; or three (3) to four (4) years related experience and/or training; or an equivalent combination of education and experience.
</li><li>Proficient working knowledge of Microsoft Office suite products.
</li><li>Familiarity with Tableau is a plus.</li>
</ul>
SALARY RANGE

The pay range for this position is $55,000 to $75,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
PERKS &amp; BENEFITS
<ul>
<li>4 weeks accrued paid time off + 9 paid national holidays per year</li>
<li>Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)</li>
<li>Annual 401(k) Employer Contribution</li>
<li>Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
</li><li>Robust health and wellness program and fitness reimbursements</li>
<li>Various Paid Family leave options including Paid Parental Leave</li>
<li>Tuition Reimbursement
</li></ul>ABOUT THE COMPANY

The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of &ldquo;A-/Excellent&rdquo;.

#LI- DNI</div>

Claims Representative, PIP Litigation

DAMANA

<div>
 
 
 Company Overview
 
 
 
 
 Damana
 
 is a leading player in the insurance industry, committed to delivering innovative, technology-driven solutions to our clients. We are currently seeking a highly skilled
 
 Digital Business Analyst
 
 to join our
 
 Enterprise Architecture Team
 
 and support digital transformation initiatives within the
 
 medical insurance
 
 domain.
 
 
 
 
 
 
 Position Summary
 
 
 
 As a
 
 Digital Business Analyst
 
 specializing in
 
 medical insurance
 
 , you will analyze and optimize business processes related to
 
 medical claims
 
 ,
 
 policy administration
 
 , and
 
 adjudication workflows
 
 . You will support digital initiatives through structured documentation, process mapping (using
 
 Microsoft Visio
 
 ), and technical collaboration. Your role also includes identifying and mitigating
 
 Fraud, Waste, and Abuse (FWA)
 
 , ensuring compliance, and delivering insightful analytics through tools such as
 
 Power BI
 
 .
 
 
 You will work cross-functionally with business, compliance, and technology teams to drive efficient, secure, and compliant operations.
 
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 Requirements Gathering &amp; Analysis
 
 
 <ul>
 <li>
 Collaborate with stakeholders to gather and document business and functional requirements related to medical claims and insurance policies.
 </li>
 <li>
 Translate complex business needs into clear documentation, including user stories and functional specifications.
 </li>
 <li>
 Ensure business rules related to
 
 ICD/CPT coding
 
 ,
 
 claims adjudication
 
 , and
 
 FWA handling
 
 are accurately captured.
 </li>
 </ul>
 
 
 Medical Claims, Adjudication &amp; FWA Analysis
 
 
 <ul>
 <li>
 Analyze end-to-end workflows for
 
 medical claims processing
 
 , adjudication rules, and benefit validation.
 </li>
 <li>
 Support rule configuration and decision logic for claim approvals, denials, co-pays, and benefit limits.
 </li>
 <li>
 Identify patterns of
 
 Fraud, Waste, and Abuse (FWA)
 
 and propose preventive and detection mechanisms.
 </li>
 <li>
 Collaborate with compliance teams to align with medical insurance regulations and audit requirements.
 </li>
 </ul>
 
 
 Business Process Analysis
 
 
 <ul>
 <li>
 Use
 
 Microsoft Visio
 
 to document and maintain detailed process maps and flowcharts.
 </li>
 <li>
 Apply
 
 BPMN standards
 
 to model current (as-is) and future (to-be) processes for claims, policy, and adjudication functions.
 </li>
 <li>
 Propose automation and process optimization opportunities for digital transformation.
 </li>
 </ul>
 
 
 Business Intelligence &amp; Analytics
 
 
 <ul>
 <li>
 Develop dashboards and reports using
 
 Power BI
 
 or other analytical tools to monitor claim trends, exceptions, FWA indicators, and performance KPIs.
 </li>
 <li>
 Analyze structured and semi-structured data to generate actionable business insights.
 </li>
 <li>
 Collaborate with data and actuarial teams to support advanced analytics and forecasting.
 </li>
 </ul>
 
 
 Release Management
 
 
 <ul>
 <li>
 Define deployment plans for changes to claims processing systems, adjudication engines, or policy management platforms.
 </li>
 <li>
 Support testing, UAT, go-live, and post-implementation documentation and training.
 </li>
 <li>
 Ensure change releases are well-governed, traceable, and aligned with business needs.
 </li>
 </ul>
 
 
 Enterprise Architecture Support
 
 
 <ul>
 <li>
 Create and maintain architecture diagrams (applications, databases, integrations) in EA tools.
 </li>
 <li>
 Ensure solutions align with enterprise architecture principles and documentation standards.
 </li>
 <li>
 Maintain updated assets and business process models in the EA repository.
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 Bachelor's degree in
 
 Computer Engineering
 
 ,
 
 Information Systems
 
 , or a related field.
 </li>
 <li>
 Proven experience as a Business Analyst in the
 
 insurance sector
 
 , particularly
 
 medical insurance
 
 .
 </li>
 <li>
 
 Strong domain expertise in:
 
 </li>
 <li>
 
 ICD and CPT coding
 
 </li>
 <li>
 
 Medical claims adjudication
 
 </li>
 <li>
 
 Medical policy structures and benefit rules
 
 </li>
 <li>
 
 Fraud, Waste, and Abuse (FWA)
 
 analysis in healthcare claims
 </li>
 <li>
 Proficiency in:
 </li>
 <li>
 
 Microsoft Visio
 
 for process modeling
 </li>
 <li>
 
 Power BI
 
 or similar BI/reporting platforms
 </li>
 <li>
 
 Java
 
 ,
 
 APIs
 
 ,
 
 Python
 
 ,
 
 MongoDB
 
 , and
 
 SQL
 
 </li>
 <li>
 
 Enterprise Architecture tools
 
 </li>
 <li>
 Excellent documentation, communication, and analytical skills.
 </li>
 <li>
 Ability to work across departments in a fast-paced, compliance-focused environment.
 </li>
 <li>
 Knowledge of
 
 project management
 
 or exposure to
 
 Agile/Scrum
 
 is a plus.
 </li>
 </ul>
</div>

Digital Business Analyst

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