Claims Analyst I

Claims Analyst I

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Title: Claims Analyst I

Location: Syracuse, NY

Duration: 3+ Months (Possible extension)

Responsibilities:

Mon- Fri 9am to 5:30 with OT possibly

Processing claims about 60 a day

Manager would like to have at least one year claims knowledge. Looking for medical claims experience for these position

Top Three: Claims knowledge, efficient and work well with a group

This is a fast paced environment. These positions have been created to hit a deadline

Interviews: Phone screens first and then face to face

Summary:

Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments.

Investigates problem claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future. Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments.

Testing categories include but are not limited to the following: Benefit, Contract, and Fee Schedule Configuration System Enhancements

Report Validation: Validation of electronic file loads.

Essential Functions:

Performs claims systems testing and/or system analysis to ensure accuracy of the system's configuration and provider payments.

Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.

Develops/creates test plans/scripts which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts.

Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing by identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations.

Complies with performance standards by completing assignments within the specified time.

Knowledge/Skills/Abilities:

Excellent verbal and written communication skills

Ability to abide by company policies

Maintain regular attendance based on agreed-upon schedule

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

Ability to establish and maintain positive and effective work relationships with co-workers, clients, members, providers and customers.

Required Education:

High School graduate (or GED) / AA preferred

Required Experience:

0-2 years of claims processing with advancement to auditing / claims analysis / claims research. Level of autonomy/decision making required.

Mid-level decision making.

Some project management skills. Good oral and written communication skills. Advanced Word and Excel skills.