Claims Analyst

4 weeks ago


San Antonio, United States Frontier Management (OR) Full time
POSITION SUMMARY/RESPONSIBILITIES
Community First Health Plans (partnered with University Health) is actively hiring experienced CLAIMS Analyst for their newly obtained STAR PLUS program. The CLAIMS analysts 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 in complex claim issue resolution . Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP . Operate under limited supervision.

EDUCATION/EXPERIENCE
High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP , Medicaid, HMO, PPO, ASO.

If you take pride in your work and are passionate about serving your community. Please click the link below to apply.
  • Pre-Claims Analyst

    7 days ago


    San Antonio, Texas, United States Texas Healthcare Solutions Inc Full time

    Key ResponsibilitiesThe Pre-Claims Analyst adheres to all legal and ethical standards concerning the agency's products and services. The Pre-Claims Analyst ensures compliance with established policies and procedures. The Pre-Claims Analyst reviews account documentation and takes appropriate actions as directed. The Pre-Claims Analyst assists in identifying...


  • San Antonio, Texas, United States South Texas Radiology Group Full time

    Position Title: Claims Recovery Analyst Department: Credit Balance Management Location: San Antonio, Texas (on-site) Reports To: Senior Manager, Patient Account Services FLSA Status: Non-exempt Position Overview:The Claims Recovery Analyst is tasked with overseeing the management of overpayment inquiries and the recoupment process within the Radiology...

  • Claims Analyst

    4 months ago


    San Antonio, United States University Health Full time

    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 in complex claim issue resolution. Work cooperatively with Configuration in...

  • Claims Analyst

    3 days ago


    san diego, United States Apex Systems Full time

    Claims Support AnalystApex Systems is hiring a Claims Support Analyst to join the team with one of our Fortune 500 Energy clients in San Diego, CA. Location: Hybrid (San Diego, CA) *Must live in commutable distance to San Diego, CADuration: 1-year contract to startPay: Starting at $40/hr. w/ flexibility depending on years of experienceShift: 40 hours/week,...

  • Claims Analyst

    3 days ago


    San Diego, United States Apex Systems Full time

    Claims Support AnalystApex Systems is hiring a Claims Support Analyst to join the team with one of our Fortune 500 Energy clients in San Diego, CA. Location: Hybrid (San Diego, CA) *Must live in commutable distance to San Diego, CADuration: 1-year contract to startPay: Starting at $40/hr. w/ flexibility depending on years of experienceShift: 40 hours/week,...

  • Claims Analyst

    3 days ago


    San Diego, United States Apex Systems Full time

    Claims Support AnalystApex Systems is hiring a Claims Support Analyst to join the team with one of our Fortune 500 Energy clients in San Diego, CA. Location: Hybrid (San Diego, CA) *Must live in commutable distance to San Diego, CADuration: 1-year contract to startPay: Starting at $40/hr. w/ flexibility depending on years of experienceShift: 40 hours/week,...


  • San Antonio, Texas, United States Frontier Management (OR) Full time

    POSITION OVERVIEW/RESPONSIBILITIES Frontier Management is seeking skilled CLAIMS Analysts to join our dynamic team, focusing on our comprehensive healthcare programs. The CLAIMS Analysts will evaluate intricate issues related to claim settlements, eligibility criteria, supplementary insurance, transplant cases, and system-related challenges that exceed...

  • Claims Analyst

    2 months ago


    San Diego, United States KellyMitchell Group Full time

    $19.60 - $28.00 (est. hourly pay rate) Job Summary:Our client is seeking a Claims Analyst who will investigate and analyze recovery and subrogation and/or liability and property damage claims filed by or against the company. This job is located in San Diego, California. Duties:Adjust and settle claimsGather evidence for hearings, trials, and other...

  • Claims Analyst

    2 months ago


    San Diego, United States KellyMitchell Group Full time

    $19.60 - $28.00 (est. hourly pay rate) Job Summary:Our client is seeking a Claims Analyst who will investigate and analyze recovery and subrogation and/or liability and property damage claims filed by or against the company. This job is located in San Diego, California. Duties:Adjust and settle claimsGather evidence for hearings, trials, and other...

  • Lead Claims Analyst

    2 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors, emphasizing a physician-led approach that prioritizes patient care. Our focus is on fostering health and wellness among our patients through comprehensive care management.The Senior Claims Examiner plays a crucial role in supporting our operations by meticulously reviewing,...

  • Lead Claims Analyst

    2 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors, focusing on a patient-centered approach that prioritizes well-being. Our commitment to excellence drives us to support our patients through tailored healthcare solutions.The Senior Claims Examiner plays a pivotal role in our operations by delivering comprehensive claims support....

  • Lead Claims Analyst

    2 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors through innovative care models. Our focus is on enhancing the health and well-being of our patients by providing comprehensive support and services tailored to their needs.The Senior Claims Examiner plays a crucial role in our operations by delivering essential claims support....

  • Lead Claims Analyst

    2 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors through a physician-led approach. Our mission is to enhance the health of our patients by ensuring they receive the necessary care from compassionate professionals. We collaborate with various Medicare Advantage health plans and are committed to expanding our services.The Senior...

  • Lead Claims Analyst

    7 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is a worldwide organization dedicated to enhancing health outcomes through innovative technology and comprehensive care solutions. The contributions made by our team play a crucial role in connecting individuals with essential healthcare services, pharmacy benefits, and vital resources to promote well-being. Our workplace fosters a culture...


  • San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors through a physician-led approach. Our commitment is to ensure that our patients receive the necessary care from compassionate healthcare professionals. We collaborate with various Medicare Advantage health plans and are poised for ongoing expansion.The Senior Claims Examiner plays...

  • Lead Claims Analyst

    7 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is dedicated to transforming healthcare delivery for seniors, ensuring they receive the necessary care from compassionate professionals. Our innovative care model focuses on enhancing the health of our patients while collaborating with various Medicare Advantage health plans.The Senior Claims Examiner plays a pivotal role in our operations...

  • Lead Claims Analyst

    7 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is a worldwide leader in healthcare solutions, leveraging technology to enhance the well-being of millions. The contributions you make will significantly influence health outcomes by connecting individuals with essential care, pharmacy benefits, data, and resources necessary for optimal health. Our culture is deeply rooted in diversity and...


  • San Antonio, Texas, United States University Health System- San Antonio Full time

    POSITION OVERVIEW AND RESPONSIBILITIES The Claims Auditor is accountable for the creation and upkeep of a comprehensive auditing framework for claims across various business sectors, aimed at enhancing claims processing protocols and assessing the quality of service provided to clients. This role involves pinpointing training requirements for processors and...

  • Lead Claims Analyst

    7 days ago


    San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is a worldwide leader in healthcare solutions, leveraging technology to enhance the well-being of millions. The contributions made by our professionals significantly impact health outcomes by linking individuals with essential care, pharmacy benefits, data, and resources necessary for optimal health. Our culture is rooted in diversity and...


  • San Antonio, Texas, United States Optum Full time

    Job OverviewOptum is a leading global organization dedicated to enhancing health outcomes through innovative technology and comprehensive care solutions. Our mission is to empower individuals to achieve optimal health by providing essential resources, pharmacy benefits, and data-driven insights. We foster a culture of diversity and inclusion, offering...