Claims Resolution Analyst

Now Hiring Claims Resolution Analyst Recovery

Charlotte – Hybrid Full Time

The Claims Resolution Analyst is responsible for managing and resolving denied or underpaid insurance claims on behalf of PMMC’s Recovery clients. This role serves as a key liaison between PMMC and insurance payers, advocating for appropriate reimbursement through effective communication, documentation, and payer-specific appeal processes. The position is well-suited for a detail-oriented, analytical professional who can work independently in a performance-driven environment.

• Research, analyze, and resolve denied or underpaid claims by engaging directly with insurance payers
• Communicate with payers to obtain claim information, present appeal arguments, and pursue proper reimbursement
• Prepare and submit appeal and reconsideration letters in alignment with payer requirements
• Perform ongoing follow-up to ensure timely resolution of assigned accounts
• Maintain accurate, organized documentation in accordance with departmental standards
• Manage an individual claim pipeline while meeting established performance metrics, including:
• Maintaining a personal pipeline of $2.4M–$2.6M
• Keeping fewer than 60 accounts with more than 21 days since last follow-up
• Achieving a minimum of $380K in monthly collections
• Collaborate with internal teams and leadership to share payer insights and resolve complex claim issues
• Uphold professional standards in all communications with payers, clients, and internal stakeholders

• Bachelor’s degree in Finance, Economics or Healthcare Administration
• Strong analytical, organizational, and time-management skills
• Ability to interpret contract language and apply payer-specific appeal processes
  
  Excellent written and verbal communication skills
• Ability to work independently and manage a high-volume workload
• Comfort working in a performance- and metrics-driven environment

PMMC is an equal opportunity employer. Weprovideequal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, veteran status, marital or citizenship status or any other status protected by applicable federal, state, or local law.