Healthcare Claim Validation Analyst

This full-time position will work on a hybrid model (1-2 times per week in the office). The ideal candidate will live within 50 miles of one of our office locations (Exeter NH or Burlington VT)

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Claim Validation Analyst, you'll play an integral role in data mining, finding anomalies, and validating our findings for external clients. We're looking for candidates with a claims experience, (coding, validating, processing, adjusting, or any combo of experience) who can research, identify claims issues tied to coding inconsistencies, provider contracting, pricing, and reimbursement policies.

Responsibilities:

· Participate as a liaison between the business, business partners, and external vendors.

· Translate multifaceted business needs and requirements into specific and complex applications.

· Conduct concept validation with the ability to analyze large data sets to be able to trend and research anomalies.

· Ability to investigate, research, and adhere to medical coding guidelines.

· Maintain awareness of variances in medical policies that may apply to concept execution and design.

· Effectively research leads and identify ideas for additional overpayment opportunities.

· Act as a resource for business partners to address any issues, concerns, discrepancies, questions, and ability to provide support or SME for the team.

· Ability to follow procedures and be able to document client-specific processes and procedures.

· Ability to manage and prioritize work assignments and projects based on business needs.

· Uphold high standards with sensitive data handling and client confidentiality.

· Contribute to team growth with innovation and agility.

Adhere to team and role expectations.

Requirements

• Active CPC certification.
• 3-5 years of experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.
• Medical terminology knowledge and working experience with industry stand Claim Edits.
• Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.
• Strong interpersonal skills with excellent verbal and written communication skills.
• Proficiency with all MS Office 365 applications.

Who We Are:

Cobalt Benefits Groups is a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.

With over 30 years of experience and a dedicated team of more than 195 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, and COBRA. Join us as we match employers across our region with the right solutions for their employee benefit needs.

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