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Title
Text copied to clipboard!Health Insurance Claims Analyst
Description
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We are looking for a Health Insurance Claims Analyst to join our team and support the accurate and timely processing of health insurance claims. This role is essential in ensuring that claims are reviewed, analyzed, and adjudicated in accordance with policy guidelines and regulatory requirements. The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing systems.
As a Health Insurance Claims Analyst, you will be responsible for reviewing submitted claims for completeness and accuracy, verifying patient eligibility and coverage, and determining the appropriate reimbursement based on the policy terms. You will work closely with healthcare providers, policyholders, and internal departments to resolve discrepancies and ensure claims are processed efficiently.
This position requires excellent analytical skills, attention to detail, and the ability to interpret complex insurance documents. You should be comfortable working in a fast-paced environment and be able to manage multiple tasks simultaneously. Familiarity with HIPAA regulations and other healthcare compliance standards is essential.
In addition to technical skills, strong communication and customer service abilities are important, as you will often need to explain claim decisions and processes to stakeholders. You will also contribute to process improvement initiatives and help identify trends or issues that may impact claim accuracy or turnaround time.
This is a great opportunity for someone with experience in health insurance or medical billing who is looking to grow their career in a dynamic and supportive environment. If you are detail-oriented, organized, and passionate about healthcare administration, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Review and analyze health insurance claims for accuracy and completeness
- Verify patient eligibility and coverage details
- Determine appropriate reimbursement based on policy terms
- Communicate with providers and policyholders to resolve claim issues
- Ensure compliance with HIPAA and other regulatory standards
- Document claim decisions and maintain accurate records
- Identify and report claim trends or discrepancies
- Collaborate with internal departments to improve claim processes
- Assist in training new team members on claims procedures
- Respond to inquiries regarding claim status and decisions
Requirements
Text copied to clipboard!- Bachelor’s degree in healthcare administration, business, or related field
- 2+ years of experience in health insurance claims processing
- Strong knowledge of medical terminology and coding systems (ICD, CPT)
- Familiarity with insurance policies and reimbursement procedures
- Excellent analytical and problem-solving skills
- Proficiency in claims management software and Microsoft Office
- Strong attention to detail and organizational skills
- Ability to handle confidential information with discretion
- Effective communication and customer service skills
- Knowledge of HIPAA and healthcare compliance regulations
Potential interview questions
Text copied to clipboard!- How many years of experience do you have in health insurance claims processing?
- Are you familiar with ICD and CPT coding systems?
- Can you describe a time you resolved a complex claim issue?
- What claims management software have you used?
- How do you ensure compliance with HIPAA regulations?
- What strategies do you use to manage multiple claims efficiently?
- Have you worked with both providers and policyholders before?
- How do you stay updated on changes in insurance policies?
- What steps do you take to ensure claim accuracy?
- Are you comfortable working in a fast-paced environment?
