Claims analyst

divh2Claims Analyst/h2pJob Title: Claims Analyst/ppLocation: Omaha NE 68154/ppDuration: 12 months/ppJob Description:/ppFamily Summary/Mission/ppAchieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations./ppPosition Summary/Mission/ppReviews and adjudicates routine claims in accordance with claim processing guidelines./ppFundamental Components Physical Requirements include but are not limited to/pp(* denotes essential functions)/pp Analyzes and approves routine claims that cannot be auto adjudicated. (*)/pp Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*)/pp Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues./pp Routes and triages complex claims to Senior Claim Benefits Specialist. (*)/pp Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*)/pp May facilitate training when considered topic subject matter expert. (*)/pp In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*)/pp Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*)/ppPerformance Measures/ppBackground/Experience Desired/pp Experience in a production environment./pp Claim processing experience./ph2Qualifications/h2pEducation and Certification Requirements/ppHigh School or GED equivalent./ppAdditional Information (situational competencies, skills, work location requirements, etc.)/pp Ability to maintain accuracy and production standards./pp Analytical skills./pp Technical skills./pp Oral and written communication skills./pp Understanding of medical terminology./pp Attention to detail and accuracy./ppAll your information will be kept confidential according to EEO guidelines./p/div