Healthcare Claims Analyst Professional

4 days ago

Honolulu, Hawaii, United States AlohaCare Full time
Join Our Team as a Healthcare Claims Analyst

Are you passionate about working in the healthcare industry and improving patient care? Do you have experience in claims processing and analysis?

About AlohaCare

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers.

Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment.

We offer a supportive and positive work environment, healthy work/life balance, continuous communication, and a generous benefits package. AlohaCare's leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs.

Salary Information

The estimated salary range for this position is $24.00 - $30.00 per hour. Salary may vary based on experience and qualifications.

Job Description

The Claims Analyst will be responsible for leading special project activities to improve the efficiency/reduce cost of processing claims. These activities could include developing new processes or recruitment activities with providers to improve the claims end-to-end experience.

Primary Responsibilities:
  • Analyze data trends to identify areas for process improvement and develop strategies to implement changes.
  • Review pended claim reports to identify opportunities for process automation and analyze areas of improvements.
  • Develop and maintain requirements/business rules for claims enhancements to comply with Federal and State requirements.
Key Skills and Qualifications:
  • High school diploma or equivalent required; Bachelor's Degree preferred.
  • Minimum of five (5) years of claims processing experience and/or equivalent combination of education, experience, and credentialing.
  • Excellent verbal and written communication skills required.
  • Ability to analyze data sets and trends for anomalies, outliers, trend changes, and opportunities.
  • Highly proficient skills using Microsoft Programs; Word, Excel, and Outlook, and data analytic tools.
Benefits

AlohaCare offers a comprehensive benefits package including low-cost medical/vision, dental, and drug insurance, Paid Time Off (PTO) Plan, 401k employer contribution, referral bonus, and pretax transportation and parking program.

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