Ensure accurate and timely resolution of insurance claims through careful review, investigation, and collaboration.
Review adjudicated claims for accuracy and compliance.
Evaluate claims processing policies, guidelines, and provider contracts.
Analyze historical overpayment trends and claims data to identify patterns or outliers.
Assess insurance claims to determine coverage, liability, and eligibility.
Confirm key claim details such as claim ID, date of service, refund amounts, and overpayment reasons.
Validate claim information in internal systems and match details against provided documentation.
Conduct thorough investigations, gathering all relevant documentation needed for resolution.
Work closely with internal teams and insurance adjusters to gather information and resolve issues.
Support team members as needed to ensure smooth project execution.
Calculate correct claim payments.
Maintain clear, organized records of claims, findings, and communications.
Track overpayment projects and ensure high-quality, timely updates.
Follow all client and company policies without exception.

Senior Reporting Analyst, Healthcare Claims

Key skills