Claims Analyst - Remote Nationwide

Lumeris Carson City , NV 48811

Posted 2 months ago

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, you'll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris.

Position:

Claims Analyst - Remote Nationwide

Position Summary:

The Claims Analyst is a part of the Services team and is responsible for researching and processing moderately complex claims. These claims are both paper and electronic and follow CMS guidance. The Claims Analyst applies specific and market focused processes to provide service support to clients as needed. This role includes solving claims issues, detailed reporting, adjustments and escalations.

Job Description:

Primary Responsibilities

  • Investigates and processes moderately complex claims

  • Handles challenging situations and acts with appropriate level of urgency when necessary

  • Follows precise instructions when processing claims

  • Completes assigned work and maintains production and quality standards

  • Extensively interacts cross-functionally to support resolution of claim issues

  • Researches and resolves adjustment inquiries

  • Performs edit resolutions from pended paper and electronic claims using critical decision-making skills for accurate claims processing

  • Works complicated reports, which involves critical decision making on adjustments, overrides of copayments, coinsurance, correct pricing and provider selection

  • Performs side by side comparisons to determine corrected claim actions

  • Issues letters & forms when appropriate

  • Performs initial overpayment recoupment process in the overpayment application

Qualifications

  • High school diploma or general education degree (GED)

  • 3+ years of experience in a related role

  • Basic knowledge and understanding in operational processes and complicated pricing calculations for medical/hospital claims processing

  • Demonstrated experience researching and understanding complex information (such as government regulations, contracts, etc.), as well as solving complex or ambiguous problems

  • Strong attention to detail and experience with analyzing

  • Ability to work independently in a fast-paced environment with competing priorities

  • Flexibility and adaptability to frequently changing guidelines and processes

  • Ability to learn and maintain knowledge of medical benefits and how they are administered and Medicare fee schedules, as well as Federal, State, and local healthcare regulations

  • Demonstrated ability to collaborate with internal and external stakeholders and communicate effectively through both written and verbal modalities

  • Proficiency with business applications like Microsoft Office Suite

  • Demonstrated experience working with 10-key and excellent keyboarding skills

Preferred Qualifications

  • Experience in Claim Processing is a plus

  • Bachelor's degree preferred

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

  • The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Location:

Addison, TX, Addison, TX, Ann Arbor, MI, Apollo Beach, FL, Arlington, TX, Atlanta, GA, Austin, TX, Baltimore, MD, Barrow, GA, Bartow, FL, Baton Rouge, LA, Boston, MA, Brandon, FL, Braselton, GA, Carson City, NV, Charlotte, NC, Chicago, IL, Clearwater, FL, Columbus, OH, Dade City, FL, Dallas, TX, Dayton, OH, Denver, CO, Detroit, MI, Durham, NC {+ 40 more}

Time Type:

Full time

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Claims Analyst - Remote Nationwide

Lumeris