Claims Analyst (Troy, MI

Please see below for a current listing of available positions at Bene Sys.

Position:Claims Analyst (Troy, MI)

Location: Troy, MI

Job :2652

# of Openings:1

Claims Analyst (Troy, MI)

Summary – The Claims Analyst will be responsible for medical, dental, and vision claims processing of claims submitted electronically or on hard copy. Each Analyst will specialize in a particular group but is expected to handle claims processing for multiple groups.

Applicants for this remote role will only be considered if they live in these locations:
Arizona, California, Colorado, Washington DC, Iowa, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Michigan, Missouri, Nevada, Ohio, Oregon, Pennsylvania, Texas, Utah, Washington, Wisconsin.

• Review claims for benefit determination based on exception reports of electronic claim submission or hard copy submissions.
• Make corrections when necessary to incorrect participant or provider data.
• Assist Client Services Representatives with difficult claim adjustments/corrections.
• Analyst must be able to determine benefits for multiple groups and process claims accurately according to the corresponding Plan Documents.
• Primary responsibilities will not include telephone or personal interaction with participants or providers unless; it is determined by a supervisor or manager that assistance is needed in this area.
• Regular and predictable attendance is an essential function of this job.
• Level I – Previous claims processing experience necessary. Must have working knowledge of medical terminology, CPT, ICD9/10, and HCPCS codes as well as CMS
  1500 and CMS
  1450 claim forms. Must be detail-oriented, work well independently and part of a team, self-motivated, possess analytical skills and ability to make benefit determinations utilizing plan documents. Must meet established productivity and quality expectations of 98% procedural and 99% payment/financial accuracy. Ability to process specialty claims such as flexible spending and HRAs.
• Level II – Must be proficient at all Level I skills. Complete understanding of claims processing system and assigned funds. Demonstrated ability to process all claim types and resolve complex claims including but not limited to Coalition and Hospitalist claims. Sound understanding of all aspects of the adjustment process. Ability to assist with system testing and claims auditing. Demonstrates initiative, sound judgment, and independent decision-making ability.
• Level III – Must be proficient at all Level I and II skills. Solid understanding of all claim types and the ability to assist on all funds. Ability to identify inconsistencies and elevate findings appropriately. Excellent communication skills. Ability to train and assist new hires as well as provide support for Analyst I and II’s. Conduct audits, report findings, provide detailed analysis of claims, and recommend changes for process improvement.
• Unit Lead - Must be proficient at all Level I - III skills. Must possess leadership ability and excellent communication skills both verbally and in writing. Demonstrates the ability to understand and facilitate the resolution of all complex claims issues including adjustments and appeals. Provide training to new hires and existing staff. Complete reporting for inventory, department, and individual analysts’ performance stats.
  
  Monitors inventory to ensure turn-around-times are maintained and department goals are achieved. Identifies error trends for training needs and works with the supervisor for implementation of processes to improve overall performance. Must demonstrate initiative, ability to multi-task and prioritize, and excellent organizational skills. Ability to represent the department on work groups and new system implementation.

Qualifications - Individual must have previous medical claims processing experience and knowledgeable of medical terminology (i.e., CPT codes, ICD-9 codes, HCPCS, ADA codes). Analyst must be methodical and possess the skills to determine approval for benefit payment, versus pending or denying. Analyst will be accountable for benefit determinations. Excellent customer…