*** NOTE : No Visa sponsorships supported ***
Job Description
The Claims Analyst role is responsible for analyzing and reviewing claims for accuracy and completeness.
This position is primarily responsible for claims resolution and help with managing the workflows and processes with CCA’s claims TPA.
This role will partner with various departments in CCA including Clinical, Contracting,
Provider Relations to ensure timely and accurate claims payments, provide analysis on claims trends and make recommendations for process improvement, researching various claims components and corresponding with CCA vendors.
The Claims Analyst will report to the Manager of Claims and will support various operational functions.
The role requires strong analytic skills as well as strong customer facing skills.
Will help shape the direction of the department and assist with identifying trends, root cause analysis and resolution of identified issues.
· Claims analysis and resolution
· Provides cross functional support to key Operations projects as needed.
· Assists Manager with review and analysis of weekly Claims Dashboard. Ensuring claims inventory is current.
· Identifies patterns within Claims inventory and works with Claims leadership and Claims TPA to resolve.
· Leads provider calls as Claims SME
· Works with Claims TPA on provider appeals
· Works with CCA technical staff to help design/develop claims payment rules.
· Works with team, management, and self-directed to identify and document benefits, costs and risks associated with business decisions.
. Has a strong customer services focus and communicates status issues and changes to appropriate audience..
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