Job Description

INSURANCE CLAIMS ANALYST

SAN FRANCISCO, CALIFORNIA

San Francisco, in northern California, is known for its year-round fog, iconic Golden Gate Bridge, cable cars and colorful Victorian houses. It’s part of a nine-county region that include Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano and Sonoma counties. The greater Bay Area Region is the second-largest in California (after the Greater Los Angeles area). With a low unemployment rate, San Francisco is a great place for talented healthcare professionals to live. Whether you prefer to work in a hospital, clinic, home care or senior housing setting—San Francisco Bay Area job opportunities in healthcare are abundant.

On Time Talent Solutions is seeking Insurance Claims Analysts who will handle first and third party claims in a quality manner and meet our high standards of accuracy, efficiency, quality customer service and regulatory compliance.

INSURANCE CLAIMS ANALYST RESPONSIBILITIES:

• Develop service line and physician level reimbursement analyses and models (involving multiple variables and assumptions) to support a variety of new/revised strategies, approaches, and provisions

• Coordinate, compile, model and analyze the financial/cost impact of new and existing value based care provider contracts including global payment and risk-sharing arrangements

• Refer finalized investigations to appropriate area such as Claims Ea, UW Examiner, Management, etc.

• Work with various internal stakeholders to ensure timely and equitable resolution of claims In the event of an accident, injury or contract dispute

• Assist in preparation and delivery of insurance and risk manuals and training programs for key stakeholders, as needed

INSURANCE CLAIMS ANALYST QUALIFICATIONS:

• Bachelor's degree in business, risk management, insurance or related field

• A comprehensive understanding of current episode payment methods used by CMS and by commercial payers, in addition to other complex reimbursement methodologies

• Knowledge of hospital operations, health/insurance benefit plans, and revenue cycle claims systems

• Working knowledge of ICD-9, CPT, HCPC coding and Medical Terminology

• 5-7 years relevant experience in insurance and risk is required

• Certification of Certified Risk Manager and/or other accreditations highly preferred