Medical Claim Analyst

Job Description: • Responsible for initial review and triage of claims • Determines coverage, verifies eligibility, identifies and redirects misdirects • Responsible for prepping the authorization in the system and triage cases to medical staff for review • Organized and prioritizes work to meet regulatory and claim turn-around times • Promotes communication, both internally and externally to enhance effectiveness of medical management services • Performs non-medical research and support • Adheres to Compliance with PM Policies and Regulatory Standards • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements • Protects the confidentiality of member information and adheres to company policies regarding confidentiality Requirements: • Effective communication, telephonic and organization skills • Familiarity with basic medical terminology and concepts used in care • Strong customer service skills to coordinate service delivery • 2-4 years experience as a medical assistant, office assistant or claim processor preferred • MedCompass, CEC, or ACAS experience preferred • High School Diploma or G.E.D Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job