Claims Analyst 2 - 120060BCforward • USA, North Carolina, Franklinville
Claims Analyst 2 - 120060
BCforward • USA, North Carolina, Franklinville
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job_description.job_card.job_descriptionRequired : High school diploma or GED. Preferred : Bachelor's degree in Business or related field. Experience : 2-4 years of relevant experience. Schedule : Monday-Friday, 8 : 00 AM - 5 : 00 PM. Overtime : May be required depending on workload. This is not a field-based or member-facing role. The worker will not be working in a Centene facility or worksite. Required : High school diploma or equivalent. Experience : Minimum 1 year of experience in the health insurance industry, claims processing, physician's office, or other related office services. Proficiency with Microsoft Office (Word, Excel, etc.) and ability to perform basic math functions. Working knowledge of ICD-9 / 10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred. Claims refer to dental and / or vision claims. Experience processing dental or vision claims preferred. Working knowledge of ICD-9 / 10, CDT, and dental terminology preferred. Experience with Medicaid or Medicare claims preferred. Ability to successfully complete progressive claims training programs within 12 months of hire required. Process first-time claims. Apply policy and provider contract provisions to determine claim payability. Research and determine the status of medical-related claims. Maintain records, files, and documentation as appropriate. Meet and maintain department production and quality standards. Successfully complete additional progressive claims training as required. Perform other duties as assigned. Comply with all company policies and standards. Purpose of the Team : The adjustment team is responsible for reprocessing claims that were previously paid or denied incorrectly. Requests are received via the Track-It application. Team Environment : The team communicates effectively, maintains strong collaboration, and provides constructive feedback (both positive and negative). Manage multiple tasks as workloads vary daily. Work on adjusted claims via Track-It and Risk Manager applications, apply refund checks, handle projects, and process reports. Ensure all items are completed prior to closeout days (Mondays and Wednesdays). Maintain a 97% quality and 100% production standard. Participate in onboarding activities including team introductions, system training, compliance courses, and individualized assignment training. Work fully remote within a cross-trained, collaborative team environment. Required : High School Diploma. Preferred : - Required : N / A Preferred : - Minimum 1 year of experience in the health insurance industry, claims processing, physician's office, or other office services experience. Experience with VLOOKUP and Pivot Tables preferred. Must be located within the Eastern Time Zone (EST) for remote work. Claims Processing Medical Terminology Health Insurance Knowledge
Claims Analyst 2 - 120060
BC Forward is looking for Claims Analyst 2 in Remote - EST
Position Title : Claims Analyst 2
Location : Remote - EST
Anticipated Start Date : 11 / 24
Expected Duration : 6 months
Job Type : Contract with possible extension / Temp to Hire
Shift : 8-5 Mon.-Fri. EST
Pay rate : $20.07 / hr on W2
Need : Skilled in claims processing, medical terminology, and health insurance operations.
Job Description : Position Purpose
The main purpose of a Claims Analyst is to process pending medical claims, verify and update information on submitted claims, and review work processes to determine reimbursement eligibility. Ensure payments and / or denials are made in accordance with company practices and procedures.
Job Responsibilities
- Organize and manage detailed office or warehouse records using computer systems to enter, access, search, and retrieve data.
- Prepare and review insurance claim forms and related documents for completeness.
- Provide customer service by giving limited instructions on claim procedures or providing referrals to other facilities or contractors.
- Review claims to determine coverage under policies, evaluate settlement extent, and authorize payments.
- Set reserves on payments, ensure timely disbursement of funds, coordinate or conduct claim investigations, identify claims with possible recovery from third parties, and consult with attorneys, doctors, and agents regarding complex claim dispositions.
Education / Experience
Daily Schedule (Overtime Requirements)
Field Work / Member-Facing Requirement
Work Location
Centene Job Description
Position Purpose :
Ensure timely processing of pending medical claims. Verify and update information on submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and / or denials are made in accordance with company protocols and procedures.
Education / Experience
For Centene Dental & Vision Services :
For Claims Business Unit :
Primary Responsibilities
Story Behind the Need
Typical Day in the Role
Candidate Requirements
Education / Certification
Licensure
Experience
Additional Skills
Top 3 Must-Have Hard Skills
About BCforward
Founded in 1998, BCforward is a Black-owned global leader in workforce management and digital product delivery solutions, headquartered in Indianapolis, IN. With a worldwide team of over 6,000 consultants, BCforward is dedicated to empowering human potential through its core values : People-Centricity, Excellence, and Diversity.
As an industry pioneer, BCforward provides a best-in-class workplace, fostering a culture of accountability, innovation, and optimism. Committed to equal opportunity employment, the company champions diversity and inclusion, striving to create a positive impact for its clients, employees, and communities.
Interested candidates please send resume in Word format Please reference job code 245142 when responding to this ad.
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Job Snapshot
Employee Type Contractor
Location Franklinville, NC (Onsite)
Job Type Health Care
Experience Not Specified
Date Posted 10 / 16 / 2025
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Claim • USA, North Carolina, Franklinville
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