Claims Analyst - The Panther Group

Claims Analyst

Summary:
This is a full-time Temp-to-Hire position that provides support to the Claims Administrators Department.

The Claims Analyst is responsible for review of portal entry claims, conducting error correction and quality control review and final adjudication of paper and electronic claims. Determines whether to request more information (RMI), deny, or pay Expense Reimbursement and/or Indemnity claims following organizational policies and procedures. May include initial entry of claims or review of claims which have been received via portal and/or file feed. Reviews previously processed claims to determine corrective action should be taken, which can include adjusting claims. Takes corrective action steps using enrollment, benefit and historical claim processing information.

Tasks/Responsibilities:

• Application of product, plan provisions, SOP, benefit limits and policy exclusions to determine if a claim is payable or if additional information is needed, or if a claim should be denied.
• Use multiple systems and tools; answer service requests and inquiries received from various channels.
• Research and resolve other general customer account inquiries as appropriate.
• Reviewing charges and use of payment or denial codes within established guidelines and standards.
• Maintenance of records, files, and documentation.
• Meet or exceed the standards of department production and quality standards.
• Claims processing for claims, including all associated tasks and benefit eligibility verification, and determining the appropriate of such claims.
• Acquiring additional claims substantiation and related tasks such as claim identification, member communication and closing of said claims.
• Such other duties or tasks to assist the department of organization as the supervisor may deem necessary.

Skills/Requirements:

• Must be proficient in MS Word, Excel, and Outlook.
• Excellent verbal and written communication skills required.
• Ability to work mandatory overtime during busy periods.
• Ability to meet established carrier deadlines.
• Attention to detail and an “eye for accuracy”. 
• Must have a good command of the English language, oral, and written.
• Must be able to work in a fast-paced environment with demonstrated ability to handle multiple tasks.
• Ability to maintain confidentially.
• Needs to be receptive to and accepting guidance from others.
• Ability to deal with difficult people and problems.
• Able to work well in a diverse team environment.

Physical Demands:

• Sit for long periods of time.

targeted maximum to $22/hr DOE