Claims Analyst

Tasks/Responsibilities:

Claims processing for manually submitted claims, including all associated tasks and benefit eligibility verification and determining the appropriateness of such claims.
New Group Setup
Plan Year Setup
Check printing and mailing
Per occurrence review and allocation
Facilitate internal and external audit requests.
Enrollment maintenance
Letter creation, printing and mailing (denials, repayments, RX sub & per occurrence)
Client setup and implementation for new groups and/or new products and services. Includes client coordination, internal setup and carriers.
Processing, entering and synchronizing participant enrollments
Updating contributions to CDH accounts to ensure proper funding
RX claims substantiation and related tasks such as claim identification, member communication and closing of said claims
Update and maintain member information across all systems and databases
Reporting for internal and external users
Such other duties or tasks to assist the department of organization as the supervisor may deem necessary.

Other notes on the position: They are looking for an independent, self motivated individual that will hit the ground running and wants to learn!

They will be assigned to workload claims that include: medical, mental health, durable, prescription claims, etc.
Need to be okay working alone - this is mostly independent work
Successful employees in this role have an administration background and are meticulous/pay attention to details

Must Have Skills/Qualifications

Must be proficient in MS Word, Excel, and Outlook
Excellent verbal and written communication skills required
Must be able to work in a fast-paced environment with demonstrated ability to handle multiple task
Strong attention to detail
Insurance knowledge

Rewards/Perks of the Opportunity:
We are not your typical insurance company!