sr claims analyst

The Hartford

<div>Sr Claims Analyst FL - CV08DE
We&rsquo;re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals &ndash; and to help others accomplish theirs, too. Join our team as we help shape the future. 
The Global Financial Lines Senior Claims Analyst - Allied Health Professional Liability manages complex primary and excess financial lines claims under claims‑made policies. This role applies strong technical expertise and sound judgment to evaluate, manage, and resolve claims in accordance with company standards and regulatory requirements.
Job duties include:
Claim File Management<ul><li>
Plan, recommend, reserve, and execute file strategies including investigation, valuation, disposition, and settlement of assigned claims of low to moderate exposure and/or complexity, in a manner consistent with corporate claim settlement policies and procedures, and statutory, regulatory and ethics requirements</li><li>
Appropriately escalate matters to Team Lead/management per escalation protocols</li><li>
Independently draft and issue timely reservation of rights letters on all files and independently draft denials for management review</li><li>
Properly assesses the exposure of assigned claims. Plan and organize, establish priorities, anticipate issues, determine realistic completion dates, know and communicate the status of assignments, appropriately manage vendors</li><li>
Demonstrate increasing ability and continued development with respect to appropriately interpreting and applying financial lines insurance coverage concepts, including how to trigger other insurance when indicated</li><li>
Demonstrate development regarding technical and jurisdictional expertise</li><li>
Maintain current knowledge of claim loss cost management initiatives, and utilize them appropriately and in a manner consistent with company practices and procedures</li><li>
Identify and properly utilize mitigation, subrogation, and other recovery opportunities</li></ul>
Customer Service<ul><li>
Maintain dedication to meeting or exceeding expectations and requirements of internal and external customers</li><li>
Obtain first-hand customer information; use it for improvements in products and services</li><li>
Establish and maintain effective relationships with customers, gaining their trust and respect. Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations.</li></ul>
Business Acumen and Technical Expertise<ul><li>
Utilize verbal and numerical critical thinking skills to gather information, apply sound reasoning, and draw appropriate conclusions; make sound decisions based upon mixture of analysis, experience, and judgment.</li><li>
Accurately resolve coverage and compensability issues.</li><li>
Demonstrated experience investigating, evaluating, and successfully negotiating/mediating claims to appropriate disposition.</li><li>
Possess superior analytical and critical thinking skills.</li><li>
Excellent time management abilities</li><li>
Possess the technical knowledge to properly reserve claims</li><li>
Properly apply statutory laws and regulations of applicable jurisdiction</li><li>
Demonstrate advanced expertise to utilize claim management practices to effectively manage loss costs</li><li>
Contribute to loss cost management by recognizing potential for Subrogation and Special Investigation</li></ul>
Teamwork and Team Building<ul><li>
Support and help create a team environment that celebrates diversity and Inclusion</li><li>
Support and assist in building a high performing team with diverse characteristics, where individual differences are valued</li><li>
Build appropriate rapport and constructive and effective relationships with people inside and outside the organization</li><li>
This position will handle files in more than one claims systems</li></ul>
Qualifications<ul><li>
College degree required, J.D. strongly preferred</li><li>
At least two to three years of successful relevant experience handling third-party professional liability claims or litigation, with a career history of increasing responsibility</li><li>
Experience handling allied health or medical malpractice matters strongly preferred</li><li>
Technical expertise in managing claims</li><li>
Self-starter, resourceful and independent</li><li>
Ability to work in a fast-paced environment and ability to prioritize work</li><li>
Outside the box thinking to negotiate creative resolutions</li><li>
Strong computer proficiency in utilizing software programs, knowledge of ECOS claim system a plus</li><li>
Strong communication skills, oral, written, collaboration and negotiation</li><li>
Excellent time management and organizational skills</li><li>
Superior customer service skills</li><li>
Adept at managing conflict as an opportunity to listen and share information while negotiating a win/win outcome that supports The Hartford's and the insured&rsquo;s best interests</li><li>
State adjusting licenses will be required; a plus if already obtained</li><li>
Proficiency in using Microsoft Word and Excel</li><li>
Operate under the mindset of The Hartford's Behaviors: be courageous, break through, and better the experience</li></ul>
This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL, Alpharetta, GA) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.
Compensation
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford&rsquo;s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:
$108,800 - $163,200
Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age</div>

Senior Claims Analyst - Allied Health Professional Liability

Norton Healthcare

<div>Responsibilities:
<div>
The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related charge audits, denials, quarterly HCPCS updates, and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure compliance with billing regulations while maximizing reimbursement. Additionally they provide support and education to Pharmacy and Revenue Cycle teams on coding and documentation requirements. Strong attention to detail with extensive knowledge in Pharmacy billing, coding, payor policies, federal regulations and reimbursement methodologies are essential for this role.</div><div></div><div> 
**This position offers a fully remote work opportunity. Employees in this role must reside in one of the following states to be considered for fully remote positions: Kentucky, Indiana, Missouri, Ohio, Tennessee, Alabama, Virginia, Mississippi, North Carolina, South Carolina**</div>
Qualifications:
<div>
Required:</div><ul><li>
Three years of experience in healthcare revenue cycle, clinic operations or pharmacy technician</li><li>
One of: CCA or CCS or CIC-ICD or COC or CPC or RHIA or RHIT</li></ul><div>
Desired:</div><ul><li>
One year of pharmacy experience</li></ul></div>

Senior Revenue Integrity Pharmacy Analyst, Revenue Integrity/Coding Administration, Days, Fully Remote

Nemours Children's Health

<div>Nemours is seeking a Sr. Medical Reimbursement Analyst in Jacksonville, FL.
The primary function of the Senior Medical Reimbursement Analyst is the resolution of open high dollar insurance balances through collections. The position is responsible for researching unpaid, underpaid and denied high dollar insurance claims then applying contractual billing and payment guidelines to ensure timely resolution and meet collection goals. The position also uses knowledge of the revenue cycle to analyze, report and work reimbursement issues with various internal departments and external entities at all levels to create reliable methods for future resolution.
Essential Functions 
 
<ul><li>Work accounts until all charges are paid or denied by the insurance carrier, while utilizing their ability to multitask, maintain process efficiencies and production levels.
</li><li>Understand and apply principles of reimbursement to all aspects of the revenue cycle including but not limited to billing, coding, reimbursement, recovery, and patient responsibility.
</li><li>Account for high dollar balances and keep abreast of insurance trends while identifying and reporting payor trends and issues to management and huddle board in order to affect timely resolution.
</li><li>Pursue payment from payors related to both denials and underpayment through various means of communication including verbal and written platforms i.e email, appeals, etc.
</li><li>Accurately enter patient demographics, guarantor and coverage information into Epic system. As well as, accurately perform retro adjudication, change filing order, request necessary adjustments / reversal of adjustments, or refile claims.
</li><li>Apply problem solving skills to resolve discrepancies while maintaining a professional demeanor that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours when working with either insurers or the insured.
</li><li>Work jointly with all departments along the revenue cycle to resolve issues, including attending meetings both internally and externally. Building relationships which could result in an increase of collection % as well as, ensure timely processing of claims.
</li><li>Keep abreast of all insurance and system changes, Payor Plan Standards, contractual updates, etc.
</li><li>Apply balance adjustments as appropriate and accurately bill the guarantor for patient responsibility if applicable.
</li></ul>Requirements
High School Diploma
1-3 years of experience
About Us
Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida - along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.
Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.
Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.
Learn more at Nemours.org .</div>

Medical Reimbursement Analyst Sr

Search 6782+ Sr claims analyst jobs near you this April. New roles added regularly across leading industries. Apply today.

6782 sr claims analyst jobs Near Me

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Revenue Integrity Pharmacy Analyst, Revenue Integrity/Coding Administration, Days, Fully Remote

Medical Reimbursement Analyst Sr