Benefit and Claims Analyst

divh2Job Opportunity At Highmark Inc./h2pJob Summary: This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements./ppEssential Responsibilities:/pulliCoordinate, analyze, and interpret the benefits and claims processes for the department./liliServe as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims./liliCommunicate benefit explanations clearly and concisely to all pertinent parties./liliInvestigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims./liliResearch and investigate conflicting benefit structures in multi-payor situations./liliProvide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.)/liliFollow-up on all inquiries in accordance with corporate and regulatory standards and timeframes./liliMonitor and identify claim processing inaccuracies. Bring trends to the attention of management./liliAssist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication./liliWork independently of support, frequently utilizing resources to resolve customer inquiries./liliCollaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants./liliGather information and develop presentation/training materials for support and education./liliOther duties as assigned or requested./li/ulpEducation:/pullistrongRequired:/strong High School or GED/lilistrongSubstitutions:/strong None/lilistrongPreferred:/strong Associates degree in or equivalent training in Business or a related field/li/ulpExperience:/pullistrongRequired:/strong 3 years of customer service, health insurance benefits and claims experience. Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies PC Proficiency including Microsoft Office Products Ability to communicate effectively in both verbal and written form with all levels of employees/lilistrongPreferred:/strong Working knowledge of medical procedures and terminology. Complex claim workflow analysis and adjudication. ICD9, CPT, HPCPS coding knowledge/experience. Knowledge of Medicare and Medicaid policies/li/ulpLicenses or Certifications:/pullistrongRequired:/strong None/lilistrongPreferred:/strong None/li/ulpSkills:/pulliKnowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services/liliKnowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures/liliThe ability to take direction, to navigate through multiple systems simultaneously/liliThe ability to interact well with peers, supervisors and customers/liliUnderstanding the implications of new information for both current and future problem-solving and decision-making/liliGiving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times/liliUsing logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems/liliAbility to solve complex issues on multiple levels./liliAbility to solve problems independently and creatively./liliAbility to handle many tasks simultaneously and respond to customers and their issues promptly./li/ulpLanguage (Other than English): None/ppTravel Requirement: 0% - 25%/ppPhysical, Mental Demands and Working Conditions:/pulliPosition Type: Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never/liliPhysical work site required: Yes/liliLifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely/li/ulpDisclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job./ppCompliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies./ppPay Range Minimum: $21.53 Pay Range Maximum: $32.30 Base pay is determined by a variety of factors including a candidates qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets./ppHighmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. 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