Healthcare Claims Analyst

Job Description

Job Description

Capital Health Plan is seeking a Healthcare Claims Analyst to join our team in Tallahassee, FL. In this full-time position, you will be responsible for analyzing insurance claims, determining the extent of CHP's liability, and adjudicating claims in accordance with departmental policies and provider agreements. We offer this position competitive pay!

Benefits and Perks:

• Health coverage and dental insurance
• Health and dependent care spending accounts
• Short and long-term disability
• Major disability time off (MDTO)
• Retirement plan
• Life and AD&D insurance
• Voluntary life and AD&D insurance
• Paid time off (PTO)
• Employee assistance program
• SmartDollar

THE GROWTH YOU HELP PROVIDE AS A HEALTHCARE CLAIMS ANALYST

This is a full-time position working Monday through Friday from 8:00 AM to 5:00 PM . Employees must also be willing to work evenings, weekends, and overtime as directed.

As a Healthcare Claims Analyst, you will analyze insurance claims of low to moderate difficulty to determine Capital Health Plan's liability and process claims in accordance with established policies and provider agreements. You will review submitted claims for errors and missing information, evaluate claims for payment based on provider agreements and member benefits, and issue appropriate notifications when claims are denied. Throughout the day, you will follow up on pending claims, collaborate with other departments to resolve outstanding issues, and maintain daily processing statistics. You will perform data validation on scanned and OCR claims, enter information from paper claims, monitor pending claim volumes, and notify the Claims Supervisor when established limits are exceeded. You will also refer questionable claims for further evaluation while maintaining standards for production, accuracy, and customer service. Within six months, you will be expected to demonstrate the accuracy, speed, and ability necessary to progress to claims of greater complexity.

OUR IDEAL HEALTHCARE CLAIMS ANALYST

• High school diploma or equivalent or one to three months of related experience and/or training or an equivalent combination of education and experience
• Ability to read and interpret safety rules, operating and maintenance instructions, and procedure manuals
• Ability to write routine reports and correspondence
• Ability to communicate effectively with customers and employees
• Basic math skills and ability to compute rates, ratios, and percentages and interpret bar graphs
• Ability to carry out detailed written or verbal instructions
• Ability to solve problems involving a few concrete variables in standardized situations
• Knowledge of, or ability to learn, industry-standard procedure and diagnosis codes
• Knowledge of, or ability to learn, medical terminology
• Skilled in the use of, or ability to learn, Microsoft Outlook, Word, and Excel
• Working knowledge of, or ability to learn, Adobe Acrobat software
• Ability to meet and maintain state, federal, and CHP guidelines and standards for timeliness and accuracy of claims processing
• Ability to read, understand, and interpret claim editing documentation and healthcare regulatory information
• Ability to occasionally lift and/or move up to 25 pounds

ABOUT US

As a not-for-profit healthcare organization serving the Florida Panhandle since 1982, we are committed to delivering quality, affordable, and patient-centered care. Our employees are at the heart of everything we do, and their dedication, teamwork, and commitment to exceptional service help us maintain a strong reputation for excellence. Every role contributes to our success. Whether supporting patients, assisting providers, or ensuring efficient operations behind the scenes, our team members help make a positive impact on the health of our communities. We foster a workplace built on professionalism, respect, and inclusion, where employees are supported in their development and recognized for the value they bring to our organization.

HOW TO JOIN US

Be our new Healthcare Claims Analyst! We encourage you to apply today. Complete our mobile-friendly application!

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

Must have the ability to pass a background check and drug screening test.

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