Medical Claim Analyst
Core
Inspects and provides accurate claim information to support savings optimization, responds to benefit inquiries, and administers policies for medical cost management.
Role type
Medical Claim Analyst
Builds
Medical claims adjudication and cost management processes
Domain
Health insurance / Medical claims
Required skills
Problem solving, decision-making, multitasking, prioritization
Preferred skills
None stated
Technologies
CS Hub, ECHS reports, CORR tasks
Responsibilities
Execute routine and non-routine business support tasks for the Medical Claims area; Follow area protocols, standards, and policies to provide effective and timely support; Review ECHS report daily for distribution of tasks to appeal nurses; Review provider coding edits routed from non-clinical claims and prepare them for review by a clinician; Using CS Hub guidelines, review and process predetermination requests to determine review eligibility; Process CORR tasks to work or reroute as appropriate.
Seniority
Mid-level, limited supervision