Claims Analyst (Remote US)

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.

Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, and paid parental leave.

About the role

The primary responsibility of the Claims Analyst is the identification, analysis, and recovery of claim overpayments on behalf of our clients, who are commercial health insurance companies and state healthcare programs. You will research and analyze data, systems, and documents to develop new concepts or apply existing ones to identify claim overpayments, ensuring all activities are completed accurately and timely.

Responsibilities

• Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures.
• Assist clients in identifying, validating, and recovering claim overpayments.
• Validate claims to ensure the accuracy of algorithms and confirm no refund has previously been posted to the client’s system(s).
• Review and resolve disputed overpayments from clients/providers.
• Participate in knowledge sharing to brainstorm and resolve claim issues or seek clarifications.
• Identify new overpayment opportunities by reviewing CMS and Medicaid claims processing policies, adjustments by client’s internal units/other vendors, client’s claims processing policies/system(s), provider, and member contracts.
• Ideate, test, document, and submit new overpayment trends/research scenarios.
• Research potential new ideas and follow the algorithm development process.
• Assist management with concept approval information needed for client approval on specific trends.
• Represent TREND and our clients in a professional manner.
• Cooperate with team members to meet goals and complete tasks efficiently and effectively.
• Provide feedback to management regarding inventory levels, algorithm effectiveness/productivity, and new trends/ideas.
• Collaborate with TREND management to identify new opportunities, areas of improvement, and innovate potential solutions.
• Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.

Requirements

• Bachelor’s degree in accounting, business, healthcare, or a related field. Equivalent work experience in a similar position may be substituted for educational requirements.
• Excellent computer skills and proficiency in Excel.
• Strong analytical skills.
• Strong communication and interpersonal skills, with the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers.
• Attention to detail and proven problem-solving abilities.
• Excellent written and oral communication skills.
• Effective organization and time management skills.
• Highly analytical, self-motivated, and directed.
• Ability to learn, understand, and apply new technologies.
• High school diploma or equivalent required.

Preferred Skills

• Proactive, independent, and results-oriented.
• Customer and team-focused with a strong desire to be an active, long-term participant in the growth of the firm.
• Experience with medical claims processing.
• Experience in identification, analysis, and recovery of claim overpayments.

Work Environment

• This position is primarily remote and involves an indoor office environment, working in or around computers and printers.
• The nature of the work is sedentary; the employee will be sitting most of the time.
• Essential physical functions include typing and repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions include concentrating on analytical tasks, reading information, and verbal/written communication continuously throughout the day.

This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities. Employees may be asked to perform other duties as required, including compliance-related tasks such as background checks, drug screenings, and disclosures of personal health or identifiable information.

The Claims Analyst position is eligible for a performance-based incentive program designed to reward contributions toward key business goals. This role has three levels (Claims Analyst I, II, and III), and candidates will be assessed on skills and experience to determine the appropriate level at the end of the recruiting process.