Claims Analyst

Qualifications 2+ years of medical billing, medical collections, AR follow-up, or denials experience. Strong ability to read and interpret EOBs; candidates should be comfortable walking through both in-network and out-of-network EOB examples. Working knowledge of insurance claim processing, payer follow-up, claim denials, adjustments, refunds, and outstanding AR. Experience working with in-network and out-of-network medical claims. Familiarity with CPT codes, ICD codes, medical terminology, and common billing forms such as CMS-1500/HCFA and UB-04. Ability to work a high-volume claims queue while balancing speed, accuracy, and quality of documentation. Strong communication skills for payer follow-up, internal collaboration, and documentation. Adaptable, team-oriented mindset with the ability to follow established processes and build on existing training. Nice to Have Skills & Experience Experience supporting surgical, specialty, or high-volume healthcare billing environments. Experience with payer portals and EDI claim rejection workflows. Familiarity with TriZetto or similar clearinghouse systems. Experience working claims for major commercial payers such as Horizon, Aetna, Cigna, or similar carriers. Out-of-network claims experience, especially with longer aging cycles or No Surprises Act-related follow-up. Job Description Insight Global’s client is seeking a detail-oriented Claims Analyst to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This individual will join a high-volume medical billing and revenue cycle team, focusing on insurance claim resolution, denials, AR follow-up, and collections across both in-network and out-of-network claims. This person will be responsible for working outstanding insurance claims, troubleshooting denials, reviewing EOBs, following up with payers, and helping resolve aged receivables across both in-network and out-of-network claims. The ideal candidate has strong medical collections experience, understands how to read and interpret EOBs, and can confidently work claims from identification through resolution. Day-to-Day Responsibilities Work a blend of AR follow-up, denials management, and medical collections based on daily claim volume, aging, and dollar amount. Review, interpret, and troubleshoot EOBs to identify claim issues, underpayments, denials, missing documentation, coding-related concerns, and payer-specific requirements. Follow up with insurance carriers through payer portals and phone calls to resolve outstanding claims and expedite payment. Manage both in-network and out-of-network claims, including claims impacted by No Surprises Act timelines and requirements. Prioritize aged receivables and high-dollar accounts while maintaining accurate documentation and claim notes. Review denials related to medical records requests, EDI rejections, coding issues, and payer processing rules. Partner with internal team members and trainers to ensure claims are worked accurately and consistently within department standards. Maintain patient and company confidentiality while ensuring all documentation is clear, accurate, and up to date. #J-18808-Ljbffr