Senior Medical Claims Analyst
2 weeks ago
Position: Senior Medical Claims Analyst
Complete Staffing Inc is collaborating with a prominent third-party insurance provider seeking to recruit two professionals with substantial experience in medical claims management.
Key Qualifications:
- Leadership Experience: Minimum of 4 years in the field, with a background in supervising a small team or demonstrating readiness for advancement.
- Bilingual Requirement: Proficiency in both English and Spanish is essential.
Compensation:
- Lead Position: $26/hour
- Bilingual Position: $23/hour
This role demands a proactive approach in a dynamic environment, requiring exceptional interpersonal and communication skills, meticulous attention to detail, and a strong capacity for multitasking and prioritization. Additionally, robust analytical skills are crucial.
Responsibilities Include:
- Evaluating covered insurance losses by reviewing policy provisions.
- Establishing proof of loss through documentation and external information gathering.
- Documenting claims by completing necessary forms, reports, and logs.
- Analyzing claims to detect and prevent fraudulent activities.
- Preparing comprehensive reports by collecting and summarizing relevant data.
- Resolving claims through the approval or denial of documentation, calculating benefits, and determining settlement amounts.
- Ensuring compliance with legal standards by adhering to company policies and state and federal regulations.
- Maintaining high-quality customer service by addressing inquiries and providing assistance.
- Offering legal support by compiling documentation for settlement processes.
- Safeguarding operations by ensuring confidentiality of claims information.
- Fostering positive relationships with insurance departments.
We are looking for dedicated individuals who can contribute to our mission of delivering exceptional service and maintaining the integrity of our claims process.
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