Claims Analyst I
New
T
TREND Health PartnersPayment Integrity
US RemoteFull-TimeEntry
Salary$50,000 - $60,000 a year
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Job Details
- Required Skills
- Data AnalysisMicrosoft ExcelAnalytical SkillsProblem Solving
Requirements
- Bachelor’s degree in accounting, business, healthcare, or related field (or equivalent work experience).
- High school diploma or equivalent required.
- Excellent computer skills and proficiency in Excel.
- Strong analytical skills with attention to detail.
- Proven problem-solving abilities.
- Effective time management and organizational skills.
- Strong written and oral communication and interpersonal skills.
- Ability to learn, understand, and apply new technologies.
- Experience with medical claims processing (preferred).
- Experience in identification, analysis, and recovery of claim overpayments (preferred).
Responsibilities
- Acquire knowledge of client claims adjudication systems, member/provider contracts, and payment policies.
- Assist in identifying, validating, and recovering claim overpayments.
- Validate claims to ensure algorithm accuracy and prevent duplicate refunds.
- Review and resolve disputed overpayments from clients and providers.
- Participate in team brainstorming to resolve claim issues.
- Research CMS and Medicaid policies to identify new overpayment opportunities.
- Ideate, test, document, and submit new research scenarios.
- Collaborate with management to identify process improvements.
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