Claims Resolution Analyst Remote-Vermont

Gainwell Technologies LLC•Any city, OH

2d•$35,000 - $50,000•Remote

About The Position

The Claims Resolution Analyst is responsible for reviewing and researching suspended claims, identifying and resolving issues and ensuring claims are processed in accordance with DVHA guidelines. This role involves analyzing claims data, coordinating with other departments and maintaining documentation to support accurate and timely claims resolution. This role plays a crucial part in ensuring claims are processed accurately and efficiently, contributing to the overall success of the claims team.

Requirements

Strong attention to detail and accuracy in claims processing.
Strong reading comprehension skills with the ability to interpret guidelines, policies, and procedures.
Proficiency in Microsoft Excel and Outlook, along with strong oral and written communication skills and the ability to adapt to changing priorities.

Responsibilities

Review and research suspended claims per DVHA guidelines.
Refer claims to the appropriate department for further review when necessary.
Process claim adjustments and corrections as needed.
Prepare and issue Return to Provider (RTP) notices for incomplete or incorrect claims.
Maintain and update claims resolution procedure documentation.
Train backup or replacement staff as needed.
Perform other duties as assigned.