Senior Claims Analyst

DRISCOLL HEALTH PLAN • Corpus Christi, TX

6d

About The Position

The Senior Claims Analyst performs highly complex and technical analysis to research, resolve, and recover health plan claims. The role coordinates departmental and project work for issue resolution and process improvement, and helps ensure that systems, processes, and reports enable the Claims Administration department to meet internal and external benchmarks. The analyst also serves as a subject matter expert on claims-related policies and procedures.

Requirements

• At least five years of professional experience in claims analysis, provider medical billing, or medical coding.
• At least two years of professional experience with claims research, adjustment, and recovery.
• High school diploma or GED.

Nice To Haves

• Experience with Texas Medicaid is preferred.

Responsibilities

• Analyze highly complex claims and claim issues to ensure correct payment, partnering with Claims Administration staff and health plan business partners to resolve issues.
• Identify trends and recommend solutions for errors found through pre- and post-payment claim and recovery reviews.
• Assist department leadership in developing daily inventory plans based on available resources, priorities, and timeliness requirements.
• Analyze provider correspondence and review requests to determine appropriate outcomes and resolutions, escalating high-priority or high-risk issues to leadership.
• Lead departmental projects and operational improvement initiatives.
• Assist with examining, assessing, and documenting business operations and procedures to support data integrity, security, and process optimization.
• Ensure adherence to state and federal compliance, reimbursement, and contract policies.
• Mentor and coach team members, assist and provide feedback to less experienced staff, and lead training for new employees.
• Participate in team meetings and contribute ideas and suggestions to improve departmental efficiency, quality, and teamwork.
• Maintain compliance with privacy and confidentiality standards.
• Meet or exceed established performance, quality, and timeliness standards.
• Demonstrate ethical business practices and comply with Health System and Health Plan policies and procedures.
• Perform other related responsibilities as requested.

What This Job Offers

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