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Claims Analyst
Location
United States
Posted
50 days ago
Salary
0
Seniority
Senior
Job Description
Claims Analyst
Curana Health
• Review, analyze, and process healthcare insurance claims for accuracy, completeness, and compliance with regulatory and plan requirements. • Monitor pending and reprocessed claims to ensure timely adjudication and payment. • Communicate with healthcare providers and insurance companies to resolve claim discrepancies and denials. • Validate the legitimacy of claims and the accuracy of invoiced amounts. • Identify and escalate potential irregularities or fraud indicators in claims data. • Compile and analyze claims-related data to identify trends, recurring issues, and opportunities for improvement. • Develop reports to track claim volumes, turnaround times, payment accuracy, and other key performance indicators. • Serve as a liaison between internal departments including Customer Service, Accounts Payable, Finance, and Legal to resolve claims issues. • Maintain current knowledge of CMS, Medicare, and payer-specific claim processing regulations. • Participate in training sessions to stay up to date on regulatory changes and system updates.
Job Requirements
- High school diploma or equivalent required; bachelor’s degree in Business, Healthcare Administration, or a related field preferred.
- 5–8 years of experience processing Medicare claims required.
- Proficiency in Microsoft Excel and Microsoft Office Suite.
- Experience with QNXT claims module required.
- Strong analytical skills to review data, identify errors, and recommend corrective actions.
- Ability to troubleshoot claim payment issues and work cross-functionally to resolve them.
- Excellent attention to detail, organizational, and communication skills.
- Ability to work independently in a fast-paced environment while meeting accuracy and timeliness standards.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
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