Claims Analyst

Grand Rapids, MI 49512

Posted: 02/27/2022 Industry: Administrative and Clerical Job Number: 7951 Pay Rate: 50000 to 60000

Job Description


Arch Staffing and Consulting in Grand Rapids is seeking a medical insurance claims analyst for one of our clients in the Grand Rapids area.
Responsibilities:
The Claims Analyst is responsible for assisting members and clients with disputes, questions and interpretation of plan descriptions and Plan Documents, as well as processing claims.

Claims Functions:
  • Medical /HRA/HSA/Dental/Vision/Flex/STD self-insured claims processing.
  • Benefit interpretation of a Summary Plan Description and a Plan Document.
  • Knowledge of the vendor role (PBMs, PPOs, Case Management) as it pertains to claims functions.
  • Adhere to claims processes and procedures.
  • Effectively adjudicate claims and meet quantity and quality standards
  • Processing all types (i.e. Coordination of Benefits, Office, Hospital) of claims while meeting department turnaround time standards.

Customer Service Functions:
  • Develop and strengthen relationships with members and clients through phone contact and call resolution.
  • Effectively utilize all customer service tools available.
  • Review and respond to verbal member and provider disputes.
  • Take an active role in Claims and Customer Service Meetings.

Qualifications Required
  • Ability to create new or modify existing Microsoft Word, Excel reports and documents.
  • Superior communication skills, both verbal and written.
  • 3-5 years’ experience in the healthcare field which would require knowledge of medical and billing terminology.
  • Familiarity with CPT/ICD-10 codes, standard health claim billing forms (UB and HCFA)
  • Experience processing all types of claims, such as COB, Medicare, dental, vision, medical, etc., etc.
  • Professional conduct at all times with an emphasis on superior customer service.
  • Excellent attendance record
  • Able to work within a team environment and assisting co-workers when needed.

Education and/or Experience**
  • Associates Degree or a combination of education and experience.
  • Minimum 2 years’ experience within a call center where customer service and the overall member experience was a priority.
  • Knowledge of trends and regulations that impact the healthcare industry.
  • Knowledge of Coordination of Benefits and Medicare preferred.

License:
  • CPC, CPC-P, CPC-H (Preferred)
  • For immediate consideration please forward your resume to this posting or call or text us at 1-844-310-Arch

 

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