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Claims Analyst
at Arch Staffing and Consulting
Grand Rapids, MI

Claims Analyst
at Arch Staffing and Consulting
Grand Rapids, MI

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Description

Job Description

The Claims Analyst is responsible for assisting members and clients with disputes, questions and interpretation of plan descriptions and Plan Documents, as well as processing claims. 

Claims Functions:

  • Medical /HRA/HSA/Dental/Vision/Flex/STD self-insured claims processing.
  • Benefit interpretation of a Summary Plan Description and a Plan Document.
  • Knowledge of the vendor role (PBMs, PPOs, Case Management) as it pertains to claims functions.
  • Adhere to claims processes and procedures.
  • Effectively adjudicate claims and meet quantity and quality standards
  • Processing all types (i.e. Coordination of Benefits, Office, Hospital) of claims while meeting department turnaround time standards.

Customer Service Functions:

  • Develop and strengthen relationships with members and clients through phone contact and call resolution.
  • Effectively utilize all customer service tools available.
  • Review and respond to verbal member and provider disputes.
  • Take an active role in Claims and Customer Service Meetings.

Qualifications Required

  • Ability to create new or modify existing Microsoft Word, Excel reports and documents.
  • Superior communication skills, both verbal and written.
  • 3-5 years’ experience in the healthcare field which would require knowledge of medical and billing terminology.
  • Familiarity with CPT/ICD-10 codes, standard health claim billing forms (UB and HCFA)
  • Experience processing all types of claims, such as COB, Medicare, dental, vision, medical, etc., etc.
  • Professional conduct at all times with an emphasis on superior customer service.
  • Excellent attendance record
  • Able to work within a team environment and assisting co-workers when needed.

Education and/or Experience**

  • Associates Degree or a combination of education and experience.
  • Minimum 2 years’ experience within a call center where customer service and the overall member experience was a priority.
  • Knowledge of trends and regulations that impact the healthcare industry.
  • Knowledge of Coordination of Benefits and Medicare preferred.

License:

  • CPC, CPC-P, CPC-H (Preferred)

 

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