Sr. Claims Analyst

Sr. Claims Analyst

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

Position Summary:

Serves as a senior resource on a team responsible for researching, processing, and resolving issues with complex claims. These claims are both paper and electronic and follow CMS guidance. Applies specific and market focused processes to provide high-level service support to clients, including occasionally making outbound calls and attending meetings as needed. Serves as a SME for claim operations. Ability and skill to work with limited guidance/supervision. Ability to follow written desk procedures. Identifies and closes gaps in claims and/or system handling.

Job Description:

Primary Responsibilities

• Processes claims and resolves issues for at all levels of complexity.
• Handles complex situations and acts with urgency when necessary.
• Prioritizes project work based on timeliness requirements.
• Works together across many departments to resolve complex claim inquiries and research issues.
• Performs adjustments and handles correspondence regarding claims.
• Works complicated reports, which involve critical resolutions on adjustments, overrides of copayments, coinsurance, correct pricing, provider selection, maximum out of pocket, etc.
• Participates in meetings with clients, vendors and internal departments related to Claims activities and acts as a client and claims SME.
• Makes outbound calls to any source needed to resolve open issues, such as members, providers, hospitals, or vendors.
• Serves as a resolution escalation point for peers. Coaches, mentors, and support junior team members.
• Leads payment integrity initiatives, from vendor interface to adjustments of findings and reporting.

Qualifications

• High school diploma, (GED) or equivalent
• 3+ years of experience in a related role or the knowledge, skills, and abilities to succeed in the role
• Advanced knowledge of Facets claims processing and adjustment handling
• Advanced knowledge of Medicare/MAO claims processing experience
• Advanced knowledge of departmental workflows, processes, and procedures
• Highly skilled at researching and understanding complex information, such as government regulations, contracts, etc.
• Ability to solve complex or ambiguous problems
• Excellent attention to detail
• Ability to work in a fast-paced environment with multiple high priorities
• Flexibility and adaptability to frequently changing guidelines and processes
• Good working knowledge and ability to maintain knowledge of Federal, State, and local healthcare regulations
• Strong collaboration skills and effective communication skills, both written and verbal
• Proficiency with business applications like Microsoft Office Suite
• Demonstrated experience working with 10-key and excellent keyboarding skills
• Sense of urgency with the ability to move from task to task effectively
• Basic experience in educating peers on department processes and procedures

Preferred

• Bachelor's degree
• CMS Audit experience

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

$54,800.00-$73,250.00

Benefits of working at Lumeris

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

No- Not Member or Patient Facing Position

Drug Screen Requirement:

No

MVR Required:

No

Credit Check Required:

No

Location:

St. Louis, MO

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.