Operational Support - Claims Review Analyst 139-1012

Job Summary

Key Responsibilities

• Audit claims, enrollment and customer service personnel daily of randomly selected work and complete appropriate forms related to the audits.
• Answer questions for claims, enrollment and customer service personnel.
• Establish training needs for employees identified during the quality review process.
• Perform other job-related duties as assigned.

Qualifications

• Ability to read and have a clear understanding of claims processing manuals, medical terminology, CPT codes and perform claims processing procedures.
• Knowledge of claims processing manuals and health benefit booklets.
• Excellent interpersonal skills and the ability to work with individuals at all levels in the organization.
• Successful completion of Health Care Sanctions background check.
• Ability to perform detailed math calculations.
• Proficient in Microsoft Office applications.
• Self-motivated with the ability to handle multiple tasks, work independently with minimal direction and meet stringent deadlines.
• Possess strong oral and written communication skills.

Education/Experience

• High school diploma or equivalent required.
• Associates degree preferred.
• Four years claim related processing experience.
• One to two years quality review/auditing experience preferred.