Talent.com
Associate Analyst, Claims Research

Associate Analyst, Claims Research

Utah StaffingLayton, UT, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Job Summary

Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards.

Job Duties

  • Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately.
  • Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction.
  • Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.
  • Meets quality and production goals.
  • Maintains detailed records of claim reviews and resolutions.
  • Identifies trends in submitted issues to inform process improvements and reduce recurring errors.
  • Provides feedback and recommendations for process improvements.
  • Completes training and development activities to stay current with industry standards and best practices.

Job Qualifications

REQUIRED QUALIFICATIONS :

  • At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience.
  • Basic knowledge of medical billing and basic claims processes.
  • Problem-solving skills.
  • Verbal and written communication skills and ability to collaborate.
  • Ability to work independently and as part of a team.
  • Microsoft Office suite / applicable software program(s) proficiency.

    • PREFERRED QUALIFICATIONS :

  • Experience with process improvement methodologies.
  • Knowledge of industry regulations and compliance standards.
  • Familiarity with systems used to manage claims inquiries and adjustment requests.
  • Understanding of billing and coding procedures.
  • Experience with Medicaid, Medicare, and Marketplace claims.

    • To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $21.16 - $38.37 / HOURLY

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
    • serp_jobs.job_alerts.create_a_job

    Research Analyst • Layton, UT, US