Operational Support - Claims Review Analyst 139-1006

CommunityCare • Tulsa, OK

1d

About The Position

Perform quality review on claims, enrollment, and customer service personnel based on select criteria determined by management. This role involves daily auditing of randomly selected output and completing appropriate forms for manager/supervisor feedback. The analyst will also work closely with trainers to address training needs identified through the quality review process.

Requirements

• Ability to read and have a clear understanding of claims processing manuals, medical terminology, CPT codes and perform claims processing procedures.
• Knowledge of claims processing manuals and health benefit booklets.
• Excellent interpersonal skills and the ability to work with individuals at all levels in the organization.
• Successful completion of Health Care Sanctions background check.
• Ability to perform detailed math calculations.
• Proficient in Microsoft Office applications.
• Self-motivated with the ability to handle multiple tasks, work independently with minimal direction and meet stringent deadlines.
• Possess strong oral and written communication skills.
• High school diploma or equivalent required.
• Four years claim related processing experience.

Nice To Haves

• Associates degree preferred.
• One to two years quality review/auditing experience preferred.

Responsibilities

• Audit claims, enrollment and customer service personnel daily of randomly selected work and complete appropriate forms related to the audits.
• Answer questions for claims, enrollment and customer service personnel.
• Establish training needs for employees identified during the quality review process.
• Perform other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED