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Claims Analyst
1 month ago
POSITION SUMMARY/RESPONSIBILITIES
Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff on complex claim issue resolutions. Work cooperatively with configuration in testing of contracts used in business operations and reporting assuring auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within your own department, with other departments and within CFHP. Operate under limited supervision.
EDUCATION/EXPERIENCE
A high school diploma or GED equivalent is required. Five years HMO/PPO claims experience are required. Amisys claims processing system experience is preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.
