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Claims Analyst

Phoenix, AZ

Role: Claims Analyst  
Hourly pay Rate $18.00
Training hours – M-F 8am to 4:30 pm
Location: Phoenix, AZ
                               
JOB DESCRIPTION
 
ROLE: Each associate will be responsible for adjudicating/adjusting claims submitted by members and providers.  The process will include reviewing claims based on preset criteria given by client, pending, approving or denying the claim on a case-by-case basis. A set of these claims will go to the prepay auditor who is expected to review the claim and audit for procedural and financial accuracy.
REPORTING TO: Team Leader/Team Manager
ESSENTIAL QUALIFICATION:
  • Overview of US Healthcare Industry
  • A-Level professional with 1-2 years of experience in  Actual Healthcare claims processing
  • Processing and adjudicating medical claims.
  • Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
  • Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
  • Working within turnaround times to meet client performance guarantees for claims processing.
  • Good logical thinking & analytical ability
  • Should have exposure to MS Office (high proficiency with MS Excel)
  • Good keyboard skills, minimum typing speed of 30 wpm or above
  • Good verbal & written communication skills, ability to interact via email/online applications
 
ESSENTIAL SKILLS/PERSONALITY TRAITS:             
  • Eye for detail
  • Logical thinking & analytical skills
  • Ability to work with limited supervision
  • Ability to work accurately and efficiently at all times, including redundant claim types
  • Ability to multi-task and manage time efficiently under the pressure of deadlines
  • Sensitivity to the confidential nature of the data and proprietary company information
 
OPERATIONAL RESPONSIBILITY:
  • Ensure to meet all Statistical, Financial and TAT metrics while processing claims
  • 100% adherence to transaction processing timelines
  • Adhere to audit compliance (Internal, Statutory Audit) of all Healthcare processes as laid out by Cognizant / the client of Cognizant
  • Ensure process guidelines are followed and met as documented
 
PERFORMANCE STANDARDS:
MEASURABLE
  • Number of claims adjudicated/adjusted in a day
  • Accurate and thorough review of all assigned claims
  • Turnaround Time
  • Attendance and Punctuality
 
NON-MEASURABLE:
  • Self-motivation
  • Team Player
  • Reliability
  • Professionalism
  • Personal grooming and etiquette
 
 
Regards,

Rahul Yadav
(408) 560-3956
rahul@reqroute.com
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs. 

ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)
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