Claims Analyst III - Full-time / Part-time

Claims Analyst III

PrideStaff, a firm specializing in recruiting for Central Oregon businesses, is seeking several Claims Analyst for level II and level III processors. In this role you will be responsible for processing claims with a high level of complexity. This will require reviewing and resolving claims using multiple systems, processes and procedures.

Responsibilities:

• Accurately process claims that fall out of the auto-adjudication system by researching benefits, claim policies, procedure and reviewing claim edits.
• Manage daily workloads to ensure production goals are met.
• Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.
• Maintain accuracy levels of 98% or higher for both payment and statistical data.
• Work in assigned work groups/queues and assist in other areas as needed.
• Provide back up assistance as needed to Customer Service Representatives in responding to phone inquiries.
• Perform other duties as assigned.

Required Qualifications:

• High School Diploma or equivalent.
• Two years experience as group health insurance analyst.
• Knowledge of medical/insurance terminology.
• Knowledge of ICD-10, CPT, and CDT.
• Research skills and ability to evaluate claims in order to resolve accurately.
• Ability to interpret health contracts and benefit language.
• Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.
• Work habits that include punctuality, ability to be a team player willing to assist and support peers, as well as work independently.
• Basic math skills.
• Ability to prioritize workloads and perform under time pressures.
• Ability to effectively use PC based systems, including moving between systems on a computer terminal. Knowledge of both WORD and EXCEL.

Preferred Qualifications:

• Ability to determine and process Third Party related claims, Coordination of Benefits and claims adjustments.
• Knowledge of contracted and non-contracted provider agreements and associated multiple tier plan designs.
• Experience performing claim audits.
• Proficient in MS Office Suite, medical terminology, medical coding
• Understanding of claims, authorization, and provider network preferred
• Excellent time management, critical thinking and research skills

Supervision: This position has supervision. The employee will meet as needed with their supervisor to go over pertinent goals and assignments. The employee does not have any supervisory responsibilities.

Basic Working Conditions: The employee must be able to sit and/or stand for long periods of time. Although this position will be in an office environment, at times this position may be required to lift up to 20 lbs. The employee will be required to have the ability to stoop, kneel and handle objects for filing.

Company Overview

PrideStaff can offer you a wide-range of rewarding career options. PrideStaff can help you find the job that best matches your skills and interests.

With offices throughout the country, PrideStaff gives you the inside track to great jobs with more than 3,000 employers.

As a PrideStaff Field Associate, you'll enjoy our generous pay and benefit package, and just as importantly, you will be treated fairly, with dignity, courtesy and respect. Work with a Staffing Firm that works for you.