The Claims Analyst will be responsible to ensure that Daily, Weekly, Monthly and Quarterly Claims Reports are submitted accurately and timely. The Claims Analyst will also be responsible for analyzing reports and identifying process improvements. Furthermore, this individual will be responsible for special Claims projects.
The timely creation and submission of the Claims Reports. Analyze reports to help identify deficiencies. Ensure daily, weekly, and monthly reports are generated timely and distributed accordingly. Additionally, must ensure database is refreshed daily to ensure accuracy of reports being distributed.|Provide analytical support to the Claims Department by creating and analyzing ad hoc reports as needed. Work closely with Management and inform them of any discrepancies in the data that is being generated.|Works closely with IT to communicate any system issues that might occur. Develops appropriate recommendations and suggestions based on analysis and collaborates with management in the development of action plans where required. Identify improvement opportunities to make reporting more efficient.|Independently create and develop high quality analytical reports, dashboards, and other data visualizations with little to no guidance from management for company-wide use. Create reports in a manner that allows for maintenance with little down time.|Strategically plans and makes logical, thoughtful, independent decisions regarding projects. Completely understands the source files and tables used in the creation of meaningful reports via Excel, Power BI, and SQL.
Three plus (3+) years’ experience as medical claims adjuster or examiner. Preferably in an IPA, MSO, or Medical Group setting. Experience handling Provider issues. High School Diploma or GED Bachelors degree.
“Location-Based Pay Adjustment”