Claims analyst

Integrated Resources Inc. Job Title: Claims analyst Location: Omaha NE 68154 Duration: 12 months Job Description: Family Summary/Mission Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/Mission Reviews and adjudicates routine claims in accordance with claim processing guidelines. Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions) • Analyzes and approves routine claims that cannot be auto adjudicated. (*) • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*) • Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. • Routes and triages complex claims to Senior Claim Benefits Specialist. (*) • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*) • May facilitate training when considered topic subject matter expert. (*) • In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*) • Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*) Performance Measures Background/Experience Desired • Experience in a production environment. • Claim processing experience. Education and Certification Requirements High School or GED equivalent. Additional Information (situational competencies, skills, work location requirements, etc.) • Ability to maintain accuracy and production standards. • Analytical skills. • Technical skills. • Oral and written communication skills. • Understanding of medical terminology. • Attention to detail and accuracy. All your information will be kept confidential according to EEO guidelines.