Job Description
Job Description
We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida.
This role involves managing the revised claims process, leading a team of claims processors, and ensuring claims are filed in a timely manner.
Responsibilities :
- Oversee the end-to-end process of claims submission, evaluation, and resolution in compliance with company policies
- Review claims to ascertain their validity, completeness, and compliance with policy terms
- Communicate with members, healthcare providers, and other stakeholders to gather necessary information and provide updates on the status of claims
- Lead and mentor a team of claims specialists, providing guidance, training, and support to ensure productivity and quality of work
- Monitor claims data, generate reports, and analyze trends to identify areas for improvement in the claims process
- Ensure that the claims process complies with all relevant regulations, policies, and procedures, including state and federal laws governing healthcare and insurance
- Address any disputes or escalations related to claims, working to resolve issues in a fair manner to both the company and the member.
- Proficiency in Allscripts and Cerner Technologies required
- Familiarity with Cl Programming and CMS Platform necessary
- Must have strong computer skills and be comfortable with various computer programs
- Experience in handling appeals in the insurance industry preferred
- Proven track record in auditing, ideally in the medical claims field
- Knowledge of benefit functions within the insurance industry required
- Familiarity with billing functions, particularly in the healthcare sector
- Must have experience in claim administration within the insurance industry
- Ability to work in a team and communicate effectively with different stakeholders
- Strong analytical skills and attention to detail
- Knowledge of insurance industry regulations and guidelines
- Ability to handle sensitive information with utmost confidentiality
- Must have excellent problem-solving skills and a strong work ethic
- Bachelor's degree in a related field or equivalent work experience required.
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Key Responsibilities:Process Medical, Disability, and Vision claims accurately and timelyResearch coverage situations and resolve claim eligibility questionsMaintain productivity expectations by processing 100-145 claims per dayRequired Qualifications:Minimum 2-3 years of experience in claim process...
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