The Claims Analyst reviews, processes and analyzes healthcare claims to determine their validity and accuracy. They assess damages, verify policy coverage and ensure compliance with regulations and company procedures. Effective communication, problem-solving and attention to detail are crucial for this role. This position is full time M-F 8am to 4pm.
ESSENTIAL RESPONSIBILITIES:
- Reviews submitted claims for accuracy, completeness and adherence to policy terms and legal requirements.
- Analyzes claim data to identify trends, patterns, and potential irregularities.
- Communicates with stakeholders to gather information, explain decisions, and resolve issues.
- Investigates potential fraudulent claims and gathering supporting evidence.
- Makes informed decisions on claim validity and determining appropriate compensation.
- Maintains accurate and detailed records of claims processing and outcomes.
- Ensures adherence to relevant regulations and company policies.
- Performs other duties as required.
JOB SPECIFICATIONS:
- High School Diploma. Associate's Degree preferred.
- 1-3 years of experience in data analysis in a customer service environment within healthcare insurance industry preferred.
- Experience analyzing data, identifying discrepancies and making informed decisions.
- Able to clearly explain complex information, both verbally and in writing.
- Able to identify and resolving issues related to claims processing.
- Strong attention to detail to ensure accuracy in claim review and data entry.
- Knowledge of Insurance/Healthcare, including understanding policy terms, coverage, and relevant regulations.
- Exceptional customer service skills.
- Covid vaccine required.
EEO Statement
Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.
Element Care is committed to valuing diversity and contributing to an inclusive working environment.
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