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Medical Claims Analyst
The Medical Claims Analyst is a role that is responsible for accurate and timely processing of our clients’ medical claims. This position requires an individual with prior claims processing experience to meet quality and production standards. This person works independently and reports to the Claims
Manager. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.
Skills required for this position:
- Strong claim knowledge/understanding as well as solid presentation, communication, facilitation, team building and decision-making skills.
- Must be able to maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with peers, customers, clients, and management.
- Proficient in Microsoft Office Suite products.
- Ability to work independently.
- Excellent organizational skills and attention to detail.
Responsible for:
- Processing medical, dental and vision claims.
- Meeting monthly Quality and Production requirements.
- Maintaining assigned block of business with minimal assistance.
- Maintaining assigned block of business additional/priorities/CRM tasks in claims system with minimal assistance.
- Assisting on non-assigned block of business with minimal assistance.
- Advising Claims System Coordinators of incorrect benefit codes or any claim issues encountered when processing.
- Reviewing and responding to Member Advocacy e-mails within 48 business hours.
- Handling renewal groups/excess claims in a timely manner.
- Performing other duties as assigned to support PBA’s Mission, Vision and Core Values
Medical Claims Analyst
Why work for PBA?
- STRONG work life balance (37.5 Hour Work Week – 7.5 Hour Day)
- Flexible Hours
- Remote work environment
- Great company culture
- Company sponsored employee events
- PTO earned after 3 months!
- Holiday Pay
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Short-Term Disability
- Flexible Benefit Plan
- 401K with company match
- Direct Deposit
- Growth potential
- Competitive pay
- Company issued laptop
Support PBA’s CORE values:
- Work together and respect each other
- Dedicated to the customer
- Be accountable and do what you say
- Take initiative and be willing to learn
- Generate positive energy
Work Environment
- This role routinely uses standard office equipment such as computers, phones, printers, and photocopiers. Essential office equipment will be provided to perform the job duties remotely.
Medical Claims Analyst
Physical Demands
- This is largely a sedentary role which requires the ability to sit for long periods of time.
- The person in this position constantly operates a computer and other office machinery, such as a calculator, copy machine, and computer printer.
- To perform the physical requirements of the position, the employee must be able to: possess manual dexterity in his or her hands in order to keyboard; see; hear, talk, walk; sit; stand; report to work and stay at work for regularly scheduled work shifts and occasional overtime; communicate clearly, cooperatively, and professionally with co-workers, supervisors, clients, and outside vendors; and maintain professional relationships with co-workers, supervisors, clients, and outside vendors.
Essential Functions Statement
- The person in this position frequently communicates with co-workers, subordinates, customers and vendors via phone and email. The person in this position must be able to exchange accurate information in these situations.
- The person in this position must demonstrate strong attention to detail to be able to properly maintain various reports and documentation, and coordinate system setups and networks.
Job Type: Full-time
Pay: $20.00 - $24.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Experience:
- ICD-10: 1 year (Preferred)
Work Location: Remote
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