About this role
Role Overview
- perform analysis by reviewing claims payments, policies, procedures and determine root cause for issues
- assist with benchmarking, business process analysis, claims processing, testing updates and claims quality audits
- ensure the appropriate identification of root cause through established intake process
- perform claim analysis and summarize results with detail at the individual level and determine impacts
- identify improvement opportunities based on analysis
- act as a claims subject matter expert
Requirements
- U.S. citizenship required
- successfully receive interim approval for government security clearance (NBIS
- National Background Investigation Service)
- 3 years of experience in managed care environment
- 4 years of claims experience processing/adjudicating professional, inpatient, and outpatient claims
- experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement
- 2 years of customer service experience
- familiarity with reimbursement terminology (ie DME, DRG, HCPCS, CPT coding, Revenue codes, etc)
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities