Claims Analyst Team B

at  Carle Health

Overview
The Claims Analyst accurately processes medical, dental, orthodontia and pharmacy claims for timely payment to providers and members. Must be able to interpret and apply a wide variety of provider reimbursement methodologies, benefit plan designs, employer/member contracts and Medicare pricing methodologies.
Qualifications

OTHER KNOWLEDGE/SKILLS:

Medical claims adjudication
Responsibilities
Adjudicates claims at a high level of productivity and accuracy as measured by individual weekly performance audits. Prioritizes, manages and balances workload daily utilizing pended claim reports, paper claim sorting and balancing to ensure performance guarantees are met and payment of interest is avoided. Corresponds as required by legislation and claim policies with providers and members by letter and phone on occasion to notify member and provider of claim denials or missing information. Researches and analyzes miscellaneous document submissions to effectively determine course of action and impact to pended or finalized claims.
About Us

Please refer the Job description for details