Remote Claims Analyst

Minimum 1-3 years claims processing experience (payer and provider sides preferred). CPT and ICD coding knowledge. Clear understanding of coding requirements and medical terminology. Intermediate to advanced understanding of Microsoft Office products (Excel, Word, Access). Ability to problem solve, exercise initiative, and make role-level decisions. Thorough understanding of claims processing compliance requirements. Ability to meet deadlines and prioritize tasks. Ability to work independently with minimal supervision. Effective written and oral communication.

Adjudicate medical healthcare claims requiring high-level review. Maintain daily production and quality requirements. Ensure adherence to federal prompt pay turnaround times. Complete pre-adjudication audit reports for payment accuracy. Attend 1:1s and team meetings. Communicate system issues to management.