Claims Analyst

Curative•Austin, TX

32d•Onsite

About The Position

Claims Analyst Curative is reimagining health care and health insurance - with straightforward pricing and $0 out of pocket costs with a baseline visit. Join our growing team and help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. Curative is searching for a Claims Analyst to review claims for completeness and process per plan guidelines. Carries out all duties while maintaining compliance, confidentiality, and promoting the mission of the organization. This position requires meeting productivity and quality standards to be successful in this role and provides the opportunity to grow your skill set and learn health plan operations. No experience necessary, we will provide training.

Requirements

No experience in claims processing is necessary, just a willingness to learn
Working knowledge of Google Sheets and Excel required
Strong computer and keyboarding skills, including familiarity with Windows
Strong interpersonal & problem-solving skills.
Strong verbal and written communication skills to communicate clearly and effectively to all levels of staff, members, and providers.
Ability to be focused and sit for extended periods of time at a computer workstation.
Ability to work in a team environment and manage priorities
Ability to calculate allowable amounts such as discounts, interest, and percentages

Nice To Haves

Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding is preferred.
Experience on the HealthEdge Health Rule Payer System is plus
College graduates preferred
Strong, demonstrated analytical skills preferred

Responsibilities

Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives.
Documents clearly and concisely claims adjudication decisions in appropriate systems. Consults appropriate reference materials to verify proper coding.
Ability to interpret and apply plan guidelines while processing to ensure correct plan setup.
Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification.
Proactively identify processes and system problems that can be improved, to reduce rework and provide accurate payment upon original processing.
Maintains timely responses to appeals and reconsideration requests
Attends and participates in departmental training, functions, and meetings.
Ability to meet/ maintain the required accuracy and production standards after release from training.
Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures
Performs other duties, functions, and projects, as assigned, by team management.