Claims Resolution Analyst

Magellan Health

11d

About The Position

The Claims Internal Resolution Analyst is responsible for coordinating the resolution of claims issues locally at the health plan by actively researching and analyzing systems and processes that span across multiple operational areas. Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing. Identifies the interdependencies of the resolution of claims errors on other activities within operations. Assists in the reviews of state or federal complaints related to claims. Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines. Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved. Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Requirements

• Requires a BA or BS.
• 5-7 years' claims experience.
• Minimum 1 year experience of complex claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry.
• Any combination of education and experience which would provide an equivalent background may be considered.

Responsibilities

• Coordinating the resolution of claims issues locally at the health plan by actively researching and analyzing systems and processes that span across multiple operational areas.
• Investigating and facilitating the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.
• Identifying the interdependencies of the resolution of claims errors on other activities within operations.
• Assisting in the reviews of state or federal complaints related to claims.
• Coordinating the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.
• Interacting with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.
• Performing claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.

Benefits

• This position may be eligible for short-term incentives as well as a comprehensive benefits package.
• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
• Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
• Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees