Claims Analyst I (US Remote)
Summary
Analyzes healthcare claims to detect and recover overpayments for insurers and state programs using client systems and policies.
TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.
Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.
The primary responsibility of the Claims Analyst is the identification, analysis and recovery of claim overpayments on behalf of our clients who are commercial health insurance companies and state healthcare programs. responsible for researching and analyzing claims, systems and documents for assigned clients in order to develop new concepts or apply existing concepts to clients that would identify claim overpayments. ensure that all activities related to successfully and correctly analyzing claims are completed in an accurate and timely manner.
Role and Responsibilities
- Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures.
- Assist client in identifying, validating, and recovering claim overpayments.
- Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s)
- Review and resolve disputed overpayments from client/provider.
- Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications.
- Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts.
- Ideate, test, document & submit new overpayment trends/research scenarios.
- Research potential new ideas and follow algorithm development process.
- Assist Management with concept approval information needed for client approval on specific trends.
- Always represent TREND and our clients in a professional manner
- Cooperate with team members to meet goals and complete tasks in an efficient and effective manner.
- Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas.
- Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions.
- Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.
Qualifications
- Bachelor’s degree in accounting, business, healthcare, or a related field. Equivalent work experience in a similar position may be substituted for educational requirements.
- Excellent computer skills and proficient in Excel
- Strong analytical skills
- Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers.
- Attention to detail.
- Proven problem-solving abilities.
- Excellent written and oral communication skills
- Effective organization, time management skills
- Highly analytical, self-motivated, and directed
- Must be able to learn, understand, and apply new technologies.
- High School Diploma or Equivalent Required
Preferred Skills
- Proactive, independent and results oriented.
- Customer and team focused with a strong desire to be an active, long-term participant in the growth of the firm overall.
- Experience with medical claims processing
- Experience in identification, analysis, and recovery of claim overpayments
Mental and Physical Demands
- This position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.
- The nature of the work is sedentary, and the employee will be sitting most of the time.
- Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
- Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.