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Claims Resolution Analyst
1 week ago
The Claims Resolution Analyst is in charge of coordinating the resolution of claims issues within the health plan by actively researching and analyzing systems and processes across various operational areas.
- Investigates and helps to resolve claims issues, such as inaccurately paid claims, by collaborating with multiple operational sectors and provider billings while analyzing the systems and processes related to member enrollment, provider information management, benefits configuration, and claims processing.
- Recognizes the interconnectedness of rectifying claims errors with other operational activities.
- Aids in examining state or federal complaints concerning claims.
- Aligns the efforts of different internal departments to determine suitable resolutions for issues within strict deadlines.
- Engages regularly with network providers and health plans to manage customer expectations, convey risks and status updates, and guarantee full issue resolution.
- Conducts claims and trend analysis, verifies the accuracy of supporting documentation, and secures necessary approvals to finalize claims issues.
Responsibilities
Requires a Bachelor's degree.
5-7 years of claims experience.
At least 1 year of experience in intricate claims research or issue resolution, or analyzing reimbursement methods in the managed care healthcare industry.
Any blend of education and experience that offers an equivalent background will be evaluated.
General Job Details
Title
Claims Resolution Analyst
Grade
21
Work Experience - Necessary
Claims
Work Experience - Preferred
Education - Necessary
A Combination of Education and Work Experience May Be Considered, Bachelor's
Education - Preferred
License and Certifications - Necessary
License and Certifications - Preferred
Salary Range
Minimum Salary:
$45,655
Maximum Salary:
$68,485
This data reflects the expected base salary range for this role based on present national figures. Minimum and maximum amounts could vary by location. Actual compensation will be adjusted considering an individual's abilities, experience, education, and other job-related factors compliant with regulations.
This role may qualify for short-term bonuses along with a comprehensive benefits package. Magellan provides a wide array of health, life, voluntary benefits, and other perks that enhance your physical, mental, emotional, and financial health.
Magellan Health, Incorporated takes pride in being an Equal Opportunity Employer and maintaining a smoke-free workplace. EOE/M/F/Vet/Disabled.
Every staff member must comprehend, adhere to, and affirm to the security commitments and controls specific to their role, and comply with all pertinent legal, regulatory, and contractual obligations, as well as internal policies and procedures.
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