Medical Claims Analyst (full-time / remote / hybrid)

Job Summary

Position responsibilities include the adjudication and processing of medical, dental, and vision claims while interpreting coding and medical terminology in relationship to the diagnosis and medical procedures.

Summary Of Essential Job Functions

• Provides claims adjudication services by reviewing, researching, investigating, adjudicating and processing claims for assigned relationships.
• Provides high-level customer service when interacting with members, Human Resource contacts, employees, providers, and internal staff.
• Has the ability to read and comprehend instructions and draft short correspondence, and memos.
• Effectively presents information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Understands all aspects of plan documents for assigned groups, and groups within their assigned pod.
• Demonstrates understanding of electronic claims from exceptions to pass-through audits.
• Identifies potential large claims and has a good understanding of the stop-loss process and pend claims appropriately.
• Performs daily duties and processes claims with minimal direction and asks questions appropriately.
• Responsible and accountable for the accurate and timely entry of claims data.
• Claims data must be entered with a high level of quality and in accordance with department claims policies and procedures.
• Consistently meets established productivity and quality standards: Minimum turn-around time is 10 days for clean claims. Claims requiring further investigation will be paid within 1 month unless extenuating circumstances arise and are documented. Once additional information is received, claims must be paid within 10 days from receipt of the documentation.

Position Requirements

• High School Diploma or GED required.
• Post HS education in medical field and medical terminology highly preferred.
• Experience – 1 to 3 years experience in an insurance or medical office setting.
• Strong customer service and communication skills required.

COMPETENCIES

• Change Management – Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
• Effective Communication – Demonstrates effective and responsive communications following the appropriate reporting structure.
• Accountability/Results – Achieves and/or exceeds result based goals that were specific, measurable, and timely.
• Teamwork – Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
• Customer Satisfaction – Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
• Professional Growth – Takes ownership of one’s professional growth within one’s current position and to advancement at PSE.

PHYSICAL DEMANDS / WORK ENVIRONMENT

• This is a sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required.
• It is encouraged that individuals intermix this sedentary time with periodic movement within one’s office space and/or to other office areas to counteract the sedentary nature of this position.

PAY & BENEFITS

• Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, personal days, 401k with match, wellness and exercise membership and more.
• To view our full-time benefits flyer, click HERE.

Opportunity

• Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.

Equal Opportunity Employer