Analyst, Claims Research (Remote)

reputed company is a career site that helps job seekers reputed company great jobs in the US. We are not a reputed company firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its reputed company clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "reputed company" or "Read more" on reputed company redirects you to the reputed company/employer site. Any information collected there is subject to their terms and reputed company notice. JOB reputed company Job reputed company Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately reputed company, identifying reputed company-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through reputed company. Essential Job Duties

• Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-reputed company claims inquiries and reputed company.
• Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
• Manages and leads major claims reputed company of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
• Assists with reducing rework by identifying and remediating claims processing issues.
• Locates and interprets claims-reputed company regulatory and contractual requirements.
• Tailors existing reports and/or available data to meet the needs of claims reputed company.
• Evaluates claims using reputed company principles and applicable state-specific regulations to identify claims processing errors.
• Applies claims processing and technical knowledge to appropriately define a reputed company for short/long-term systematic or operational fixes.
• Seeks to improve overall claims performance, and ensure claims are processed accurately and reputed company.
• Identifies claims requiring reprocessing or readjudication in a reputed company manner to ensure compliance.
• Works collaboratively with internal/external stakeholders to define claims requirements.
• Recommends updates to claims reputed company operating procedures (SOPs) and job aids to increase the reputed company and efficiency of claims processing.
• Fields claims questions from the operations team.
• Interprets, communicates, and presents, reputed company in-depth analysis of claims research results, reputed company-cause analysis, remediation plans and fixes, overall reputed company, and status of impacted claims.
• Appropriately conveys claims-reputed company information and tailors communication based on targeted audiences.
• Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
• Collaborates with other functional teams on claims-reputed company reputed company, and completes tasks reputed company designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
• Supports claims department initiatives to improve overall claims function efficiency.

Required Qualifications

• At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
• Medical claims processing experience across multiple states, markets, and claim types.
• Knowledge of claims processing reputed company to inpatient/outpatient facilities contracted with Medicare, reputed company, and Marketplace government-sponsored programs.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous reputed company and tasks to meet internal deadlines.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Customer service skills.
• Effective verbal and written communication skills.
• reputed company Office suite (including reputed company), and applicable software programs proficiency.

Preferred Qualifications

• Health care claims analysis experience.Project management experience.
• QNXT

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $21.65 - $46.42 / reputed company

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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