Claims Analyst
About The Position
Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision.
Requirements
- High school diploma or GED equivalent is required.
- Five years HMO/PPO claims experience required.
- Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.
Nice To Haves
- Amisys claims processing system experience preferred.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
Number of Employees
251-500 employees
