Job Description

Job Description

As a Claims Analyst a qualified candidate will work within our growing Health Benefits Administration team supporting our wide array of self-funded employer clients and their members. As schedules and job responsibilities there may be some opportunity for a hybrid work schedule balancing client and company needs.

Responsibilities:

• Accurately process claims by researching benefits, claim policies, procedure and reviewing claim edits.
• Answer incoming telephone calls to assist customers with explanations and issue resolution of healthcare policies, benefits, eligibility and coverage.
• Manage daily workloads to ensure production goals are met and calls are resolved timely.
• Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.
• Maintain accuracy levels of 98% or higher for both payment and statistical data.
• Work in assigned work groups/queues and assist in other areas as needed.
• Perform other duties as assigned.

Required Qualifications:

• High School Diploma or equivalent.
• Knowledge of medical/insurance terminology.
• Knowledge of ICD-10, CPT, and CDT.
• Research skills and ability to evaluate claims in order to resolve accurately.
• Ability to interpret health contracts and benefit language.
• Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.
• Work habits that include punctuality, ability to be a team player willing to assist and support peers, as well as work independently.
• Basic math skills.
• Ability to prioritize workloads and perform under time pressures.
• Ability to effectively use PC based systems, including moving between systems on a computer terminal. Knowledge of both WORD and EXCEL.

Preferred Qualifications :

Two years experience as group health insurance analyst.

• Ability to determine and process Third Party related claims, Coordination of Benefits and claims adjustments.
• Knowledge of contracted and non-contracted provider agreements and associated multiple tier plan designs.
• Experience performing claim audits.
• Experience taking inbound calls.

Company Description

We’ve got a job to do. Actually, we’ve got lots of jobs to do. Helping our employer clients do great things for their employees through their healthcare benefits is our purpose. Helping our patients live fuller, healthier, lives is our vocation. However, creating an environment in which we can all contribute, grow, and take care of our families, while fulfilling our purpose and our vocation, is the Northwind recipe for success.

If you want to be a part of something more than yourself, want to see how your work ties to that bigger purpose, need opportunities for personal, professional, and financial growth, feel that you are called to leave things better than you found them, and like to be on a winning team, Northwind might be the right place for you.

Company Description

We’ve got a job to do. Actually, we’ve got lots of jobs to do. Helping our employer clients do great things for their employees through their healthcare benefits is our purpose. Helping our patients live fuller, healthier, lives is our vocation. However, creating an environment in which we can all contribute, grow, and take care of our families, while fulfilling our purpose and our vocation, is the Northwind recipe for success.\r\n\r\nIf you want to be a part of something more than yourself, want to see how your work ties to that bigger purpose, need opportunities for personal, professional, and financial growth, feel that you are called to leave things better than you found them, and like to be on a winning team, Northwind might be the right place for you.