BusinessOperations - Claims Analyst

Medical Claims Processor

Position

Purpose:

Ensure timely processing of pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company protocols and procedures. Ability to successfully complete additional progressive claims training programs within 12 months of hire.

Education/

Experience:

High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician's office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). Ability to perform basic math functions. Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.

Story Behind the Need:
To support the NSA federal IDR process, specifically arbitration preparation. Business growth with the anticipation of a staffing decline and there are roles that require backfill. Fast-paced, collaborative, and deadline-driven work environment. Strong emphasis on accuracy, attention to detail, organization, and quality. Team-oriented culture with open communication, knowledge sharing, and cross-functional collaboration. Ability to manage multiple priorities, adapt to changing workloads, and meet regulatory timelines.

There is a possibility of upcoming hiring needs.

Typical Day in the Role:
Support the Federal No Surprises Act (NSA) Independent Dispute Resolution (IDR) process for provider disputes. Prepare arbitration cases for submission by ensuring all required documentation is complete, accurate, and compliant with federal requirements. Assist in managing data entry and dispute documentation throughout the arbitration lifecycle while meeting strict regulatory deadlines. Review arbitration disputes and supporting documentation for completeness and accuracy.

Prepare and organize arbitration packets for submission to certified IDR entities. Upload and maintain dispute documentation in SharePoint and internal tracking systems. Update the NSA lifecycle tracker with dispute details and key case information. Monitor assigned workload and prioritize cases based on regulatory due dates. Support administrative tasks related to arbitration operations, including fee payment tracking and other operational activities as assigned.

Meet established daily and weekly productivity expectations for assigned workload. This role offers exposure to a specialized, highly regulated operational process that requires collaboration across multiple business areas. This role provides opportunities to develop expertise in arbitration case management, regulatory documentation, and operational workflows. Ideal for individuals who enjoy detail-oriented work, problem-solving, and contributing to continuous process improvements in a dynamic operational environment.

Candidate Requirements:
Education/Certification

- Required:

GED/HS Diploma
- Preferred:
Licensure

- Required:

N/A
- Preferred:
Years of experience required: 2+ years of claims (preferred: Healthcare), healthcare operations, or administrative experience preferred. Disqualifiers:
No prior Amisys (Claims system) experience. Additional qualities to look for:
Prior experience with claims processing, medical billing, reimbursement, or healthcare operations is a plus.

Top 3 must-have hard skills stack-ranked by importance - 1 - Ability to accurately review, validate, and organize complex healthcare documentation while minimizing errors. 2 - Strong working knowledge of Microsoft Excel, Outlook, Teams, and SharePoint for tracking work, managing documentation, and collaborating with the team. 3 - Basic understanding of healthcare claims, with the ability to learn and apply Federal NSA IDR processes quickly.