Claims Processing Analyst

Client: Health insurance industry

Job Title: Claims Processing Analyst

Location: Hybrid in Philadelphia, PA

Duration: Contract to hire

Job Description:

• Reviews and adjudicates electronic medical claims. Determines proper handling and adjudication of claims following organizational policies and procedures
• Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures
• The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems
• Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership
• Completes productivity daily data that is used by leadership to compile performance statistics
• Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc
• Support FEP audits, including research claims related issues/questions and preparation of appropriate audit responses as well as represent IBX in the audit presentation to FEP Directors Office.
• Support assigned projects related to FEP, maintain appropriate documentations at a task level, monitor deadlines and service as subject matter expert when appropriate.
• Develop and maintain user documentation/desk level procedures ensuring the most current information is available to the claims team

Qualifications:

• High School Diploma or GED and 4 years' experience in a Claims/Service operations environment
• Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.
• Excellent written and verbal communication skills are required to provide business units with information
• Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.
• Experience in auditing, quality review or transaction processing experience