Insurance Claims & Customer Service Analyst (Full-Time/M-F, 8:00A-4:30P)
About The Position
The role of the Insurance Claims & Customer Service Analyst reports to the Billing Manager. This position reviews and processes medical claims for accuracy, ensuring compliance with policies and regulations, and providing customer service to resolve claim-related issues. This position is responsible for verifying coverage, gathering missing information from patients, analyzing claim data, and communicating with healthcare providers, policyholders, and internal teams. This position must have strong analytical, problem-solving and communication skills. The role requires strong analytical, problem-solving and communication skills and must be proficient with medical codes (like ICD-10/CPT).
Requirements
- High school diploma or GED, required.
- Proficiency with computer systems, including electronic claims processing systems and Microsoft Office Suite.
- Proficient with medical codes (like ICD-10/CPT).
Nice To Haves
- Associates degree in related field preferred.
- Previous experience in a medical office setting, including knowledge of healthcare insurance protocols, preferred.
Responsibilities
- Serve as a point of contact for customers, patients, and healthcare providers to answer questions and resolve issues.
- Communicate with stakeholders to gather necessary information and explain claim decisions.
- Provide excellent service to ensure a positive experience for customers.
- Review and audit medical claims for accuracy and completeness.
- Ensure claims comply with policy terms, legal requirements, and company procedures.
- Analyze claim data to identify trends and potential irregularities.
- Apply policy and provider contract provisions to determine if a claim is payable.
- Use computer software and systems to monitor and process claims.
- Obtain missing information from policyholders or involved persons to complete claims.
- Maintain accurate and detailed records of claims processing and outcomes.
- Prepare reports on data such as claims volume and savings.
- Submit and process insurance authorizations efficiently.
- Assist with special projects and help improve departmental policies and procedures.
- Adhere to all HIPAA privacy and 501r regulations
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
