Claims Analyst
APS Health Care PR• San Juan, PR, US, PR
•$0 - $12
About The Position
The Claims Analyst processes claims in accordance with established policies and procedures and incorporates and assures quality production principles throughout the Claims Department. The role involves claim data entry and adjudication, adjustments, validating claims, reviewing provider contractual issues and plan documents, and supporting claim audits. The analyst also processes correspondence and may assist with new-hire training.
Requirements
- High school diploma.
- At least 1 year of experience in a similar position or in data entry.
- Knowledge of Microsoft Office, including Excel, Word, and PowerPoint.
Nice To Haves
- Degree in Data Entry or a related field preferred.
Responsibilities
- Process claims using data entry and adjudication, and execute claim adjustments when needed.
- Maintain knowledge of provider contractual issues and summarize plan documents for assigned accounts.
- Identify possible coordination of benefits (COB) coverage, when applicable.
- Follow claim processing guidelines to obtain necessary information for accurate and timely processing; process routine adjustments electronically or manually while maintaining daily productivity; and receive and validate claims from internal and external clients.
- Support claim audits, including claim analysis, site visits, document preparation, and proper file storage.
- Maintain the overall quality and accuracy of financial and procedural aspects of operations.
- Receive and process correspondence when needed.
- Collaborate with new-hire training when needed.
- Comply with applicable CMS and other regulatory agency guidelines.
- Perform other duties assigned by the manager and/or supervisor.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
