Claims analyst job description

Blue Cross and Blue Shield of Vermont is looking for a Claims Analyst to join our team. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.
COVID-19 : Blue Cross is requiring all employees and covered consultants to be fully vaccinated (including booster if eligible) against COVID-19 and provide proof of vaccination as of January 1, 2022. Those with a medical condition or sincerely held religious belief preventing them from being vaccinated can request an exemption without fear of retaliation or an impact on job candidacy

REMOTE WORK : Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work two days per week in the office with flexibility to work remotely the rest of the week.

Claims Analyst Responsibilities:

Review all claims data submitted for accuracy and completeness. Analyze claims to determine appropriate coding for processing. Determine if procedure code is payable according to particular line of business. Review provider pricing files to determine allowances for correct payment. Review, investigate and resolve suspended claims relying on department procedures, using system files as necessary. Determine the correct level of coding and/or reimbursement for claims relying on department procedures, using system files as necessary.

Claims Analyst Qualifications:

High school diploma or equivalent is required. Strong data entry skills required. Knowledge of medical terminology and medical coding strongly preferred.

Claims Analyst Benefits:

Health insurance (including vision) Dental coverage (free to employees) Wellness Program 401(k) with employer match + automatic employer contribution Life Insurance Disability Insurance Combined time off (CTO) - 20 days per year + 9 paid holidays Tuition Reimbursement Student Loan Repayment Dependent Caregiver Benefits


*full job description attached to ADP posting

This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data-entered information and by analyzing claims-related information and invoice adjudication/payment for compliance with contract terms and department/regional policy and procedures. The Claims Analyst must be thoroughly familiar with outside medical systems and claims processing/adjudication processes. The position requires research, problem resolution and specialized knowledge in the areas of Medicare, Multiplan, Workers' Compensation, Coordination of Benefits and Third Party liability. The Claims Analyst may provide education and feedback to staff involved in the related processes and may assist with recovery of funds and timely response to appeals.Essential Functions:- Analyzes referrals and claims information for accuracy according to established guidelines and provides education/feedback and reports as applicable.- Assists Claims Auditor with tracing sources of inaccuracies; reports and proposes remedial action to appropriate manager.- Prepares detailed analysis of claims activity and submits reports/findings as requested.- Carries out and maintains records of special processing payment adjustments/check requested.- Works with Finance Department and others as resource regarding all aspects of Outside Medical Claims; researches and provides reports as requested.- Reviews processing of outside medical payments on a continuous basis.- Ensures safeguarding of assets through the verification of documentation, approvals and accurate coding of provider service and accounting data.- Monitors and coordinates special transactions such as check adjustments and credits.- Performs analysis of data entered for outside medical payments for the purpose of performance feedback.- Formats and prepares statistical reports and works close with CAD and local Finance Department to assist with budget monitoring and to assist with financial analysis activities.- Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding.- Performs special comprehensive reports as indicated or requested by management.

Basic Qualifications:Experience- Minimum two (2) years of claims analysis and medical billing experience.Education- High School Diploma or General Education Development (GED) required.License, Certification, Registration- N/A. Additional Requirements:- Knowledge of CPT, ICD, RBRVS, and other applicable references.- Demonstrated knowledge of both mainframe and personal computer programs.- Excellent mathematical, written and verbal skills and demonstrated medical terminology competence.- A proven ability to think and act independently and professionally.- Able to understand, develop and implement procedures.- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:- Bachelor's degree in accounting, audit, finance or management is preferred.
COMPANY: KAISER

TITLE: Claims Analyst

LOCATION: Santa Ana, California

REQNUMBER: 1097198

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Brown & Brown's Risk Solutions is looking for a Claims Analyst to join the Executive Liability Practice located in New York, NY.

As a Claims Analyst, you will support the claims team, working on Directors & Officers Liability, Employment Practices Liability, Fiduciary Liability, Crime/Fidelity, Kidnap/Ransom and Professional Liability claims for Fortune 500 companies. Responsibilities will include, but are not limited to:

Assisting in account management, renewal, special projects, and resolution of claims issues working closely with Claims Consultants and other teammates
Obtaining reports from carrier and analyzing data Assisting clients in reporting claims to carrier and analyzing data Performs claims analysis for monthly loss reporting for delivery to client Supporting clients and carriers with day-to-day email, phone, fax, and mail requests claims related matters Attending and providing follow up deliverables at claim review and audit meetings with clients and claims consultant Conducting initial review and analysis of client's policy language for presentation to claims consultant Attending any required training sessions, courses, etc. to maintain skills and licensing requirements Producing status reports to clients for various claims functions Initial reporting of claims, follow-up with the markets, coverage analysis, negotiation, and resolution of claims Maintaining a high level of communication with insurers, clients, and counsel Inputting and updating of claim materials that requires proficiency in computer program management systems.



QUALIFICATIONS:


1-2 years of technical claims experience with a carrier or broker Bachelor's Degree required JD Degree a plus Executive Liability coverage expertise Basic understanding of Technical Claims procedures and Best Practices. Ability to meet client and team needs in a timely and professional manner. Ability to set priorities and work with a minimum of supervision Mature and professional demeanor. Proficient in MS Office and strong Excel skills Excellent verbal and written communication skills Ability to use discretion and understand confidentiality issues. Proficient utilizing paperless claims systems: willingness to learn new systems



COMPENSATION & PERKS:


Excellent growth and advancement opportunities Competitive pay based on experience Discretionary time off Generous benefits package: health, dental, vision, etc. Employee Stock Program Education Assistance Program - tuition reimbursement, student loan repayment assistance, etc.


The National Executive Liability Practice is comprised of experienced and knowledgeable attorneys, brokers, and claims advisers dedicated to identifying and mitigating clients' risks. Our forward-thinking practice was one of the first to provide a revolutionizing analysis of our clients' Directors & Officers and Cyber risk profiles. The team works with clients to prevent, mitigate, and procure insurances that include Directors & Officers Liability, Employment Practices Liability, Fiduciary Liability, Crime/Fidelity, Kidnap/Ransom and Professional Liability for Fortune 500 companies and large privately held organizations.

We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.