Claims Resolution Analyst - Managed Care Exp Req - Remote CONUS

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

Required

• Requires a BA or BS.
• 5-7 years' claims experience.
• Minimum 1 year experience of complex claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry.
• Any combination of education and experience which would provide an equivalent background may be considered.
  
  

The Claims Internal Resolution Analyst is responsible for coordinating the resolution of claims issues locally at the health plan by actively researching and analyzing systems and processes that span across multiple operational areas.

• Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.
• Identifies the interdependencies of the resolution of claims errors on other activities within operations.
• Assists in the reviews of state or federal complaints related to claims.
• Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.
• Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.
• Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.
  
  

Auto req ID

425818BR

Minimum Education Required

Bachelors

Job_Category

Health/Medical other

Additional Qualifications/Responsibilities

Requires a BA or BS.

5-7 years' claims experience.

Minimum 1 year experience of complex claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry.

Any combination of education and experience which would provide an equivalent background may be considered.

General Job Information

Title

Claims Resolution Analyst

Grade

21

Work Experience - Required

Claims

Work Experience - Preferred

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelor's

Education - Preferred

License and Certifications - Required

License And Certifications - Preferred

Salary Range

Salary Minimum

$45,655

Salary Maximum

$68,485

City*

United States

State*

N/A

Job Code

Health-Services health-services

Affiliate Sponsor

Magellan Federal - AFSC