About this role

Researching, resolving, and processing provider claims while ensuring accuracy, compliance, and exceptional customer support.
Review, research, and resolve medical claims in accordance with established processing guidelines and procedures.
Analyze claims issues and coordinate with internal departments to ensure timely and accurate resolution.
Prepare and process claim-related documentation, including Return to Provider (RTP) forms when required information is missing or invalid.
Manage multiple priorities while maintaining productivity, accuracy, and service-level expectations.
Communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate.

Experience in healthcare insurance, medical claims processing, claims resolution, or a related healthcare operations environment.
Strong attention to detail, analytical thinking, and problem-solving skills.
Ability to multitask, prioritize work, and meet deadlines in a fast-paced environment.
Proficiency with Microsoft Office applications and the ability to navigate multiple systems to research and process claims.
Strong written and verbal communication skills, along with the ability to interpret policies, procedures, and operational guidelines.

Medical Claims Resolution Analyst

Key skills