Senior Healthcare Claims Analyst

2 weeks ago

Atlanta, Georgia, United States MultiPlan Full time

Imagine a workplace that empowers you to analyze, innovate, and motivate. Our team members excel by assisting healthcare payers in managing care costs, enhancing competitiveness, and driving positive transformation. You can be part of a well-established organization with a 40-year history dedicated to helping our clients succeed by assessing their needs and customizing cutting-edge healthcare cost management solutions.

Our dedication to diversity, inclusion, and belonging is woven into the fabric of our organization. We aim to cultivate an environment that promotes mutual respect and collaboration, where every talented individual can contribute and perform at their highest potential. We are MultiPlan, where exceptional individuals come to excel.

POSITION SUMMARY:

This position involves reviewing medical claims that have been paid against provider agreements and policies to ensure that payments have been processed correctly. The individual will utilize data analysis and coordination of benefits techniques to evaluate and audit hospital and physician claims to identify incorrect claim payments. Additionally, the individual will support department leadership in managing productivity and achieving quality and revenue objectives while mentoring junior team members as needed.

KEY RESPONSIBILITIES:

1. Achieve established production, quality, and growth targets.
2. Employ analytics, data analysis, and coordination of benefits techniques on client paid claims data, developing innovative algorithms and queries to uncover new savings opportunities.
3. Assess medical claims for coding and pricing discrepancies using accurate HCPCS, ICD-10, and CPT codes.
4. Review medical claims in the payer system to determine payment methods and validate identified savings.
5. Assist in training department staff on data analysis, coordination of benefits, and auditing best practices.
6. Serve as a mentor by addressing inquiries related to contracts, policies, and medical coding.
7. Support provider collection efforts and appeal resolutions as necessary.
8. Utilize official coding guidelines and resources as required, including CMS directives and bulletins.
9. Collaborate, coordinate, and communicate across various disciplines and departments.
10. Ensure compliance with HIPAA regulations and requirements.
11. Demonstrate the company’s core competencies and values.
12. Please note that due to the exposure to sensitive data, this role is classified as a High-Risk Role.
13. The responsibilities outlined above are not exhaustive; other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

POSITION SCOPE:

This role operates with minimal supervision, prioritizing the needs of both external and internal customers when making decisions and taking action. The individual will draw upon a broad range of knowledge gained through experience. The position may involve regular interaction with customers and internal staff at all levels within the organization.

The salary range for this position is $60-62K. Specific offers will consider a candidate's education, experience, and skills, as well as their work location and internal equity. This position is also eligible for health insurance, 401k, and bonus opportunities.

  • Senior Claims Analyst

    2 weeks ago

    Atlanta, Georgia, United States City of Atlanta Full time

    POSITION SUMMARY CLAIMS ANALYST - RISK MANAGEMENT DIVISIONThe City of Atlanta's Risk Management Division is in search of skilled candidates for a Senior Claims Analyst role. This division is responsible for overseeing claims made against the City of Atlanta.Role Overview and Classification StandardsThe individual selected for this role will provide...

  • Senior Claims Analyst

    2 weeks ago

    Atlanta, Georgia, United States City of Atlanta Full time

    POSITION SUMMARY CLAIMS ANALYST - RISK MANAGEMENT DIVISIONThe City of Atlanta's Department of Law is in search of skilled candidates for the role of Claims Analyst within the Risk Management Division. This division is responsible for overseeing claims made against the City of Atlanta.Role Overview and Classification StandardsThe individual selected for this...

  • Claims Fraud Analyst

    2 weeks ago

    Atlanta, Georgia, United States AIG Full time

    Claims Fraud AnalystAs a vital member of our Claims department, the Claims Fraud Analyst plays a crucial role in enhancing your expertise in the field of Claims.Impactful ContributionsThe Claims Fraud Analyst is tasked with overseeing all facets of the investigative process, which includes developing investigation strategies, pinpointing and delegating...

  • Senior Claims Executive

    2 weeks ago

    Atlanta, Georgia, United States The Ladders Full time

    Position Overview:RSUI is seeking a seasoned Senior Claims Executive to enhance our Atlanta Property Claims division. The Senior Claims Executive brings a wealth of specialized technical expertise in handling claims for our E&S commercial property sector.Work Environment:At RSUI, we foster a collaborative atmosphere that emphasizes in-person interactions,...

  • Healthcare Claims Coordinator

    3 days ago

    Atlanta, Georgia, United States Medix Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Claims Support Specialist to join our team at Medix. As a Claims Support Specialist, you will play a critical role in ensuring a quality patient experience within our service level agreements.The Claims Support Specialist will serve as a liaison between plan members, providers, and health...

  • Senior Claims Specialist

    1 week ago

    Atlanta, Georgia, United States Hiscox USA Full time

    About the RoleWe are seeking a highly skilled and experienced Senior Claims Specialist to join our team at Hiscox USA. As a key member of our Claims team, you will be responsible for resolving complex claims and providing operational support to our team.Key ResponsibilitiesAdjust and resolve complex to severe claims, including all phases of litigationDraft...

  • Senior Claims Adjuster

    2 weeks ago

    Atlanta, Georgia, United States The Ladders Full time

    Job Type: Permanent Build a successful career with The Ladders Position Overview: The Senior Claims Adjuster is a pivotal role responsible for managing intricate claims within designated authority limits while providing essential support to the claims department. Key responsibilities include: Evaluating and settling complex to severe claims, encompassing all...

  • Senior Claims Adjuster

    2 weeks ago

    Atlanta, Georgia, United States The Ladders Full time

    Job Type: Permanent Build a rewarding career with The Ladders Position Overview: The Advanced Claims Resolution Specialist is a senior-level position responsible for managing and resolving complex claims within established authority limits while providing essential support to the claims department. Key responsibilities include: Managing and settling...

  • Senior Liability Claims Specialist

    2 weeks ago

    Atlanta, Georgia, United States Berkshire Hathaway GUARD Insurance Companies Full time

    OverviewWe are in search of a Senior Liability Claims Specialist. If you have a passion for technology, possess keen attention to detail, and thrive in environments that require thorough investigations and negotiations, our team may be the perfect fit for you. We are eager to fill this role in one of our various locations nationwide.Berkshire Hathaway GUARD...

  • Senior Claims Team Leader

    2 weeks ago

    Atlanta, Georgia, United States Hiscox USA Full time

    Job Type:PermanentJoin Hiscox and Shape the FutureThe Senior Claims Team Leader is a pivotal first-line management role focused on enhancing team performance by cultivating, guiding, and inspiring a dedicated group of high-achieving claims professionals.Key Responsibilities:Foster employee engagement and professional development within the team.Monitor and...

  • Senior Actuarial Business Analyst

    6 days ago

    Atlanta, Georgia, United States Safe-Guard Products International LLC Full time

    Job SummaryWe are seeking a highly skilled Senior Actuarial Business Analyst to join our team at Safe-Guard Products International LLC. As a key member of our actuarial services team, you will be responsible for providing financial analysis, pricing, and risk assessment to estimate outcomes.Key ResponsibilitiesFinancial Analysis: Assist in the development of...

  • Senior Business Analyst

    2 weeks ago

    Atlanta, Georgia, United States Compunnel Full time

    Position Overview:The Senior Business Analyst collaborates with both internal stakeholders and external partners to define and capture essential business goals and workflows. This role involves conducting thorough research and analysis to identify business needs that inform the development of user-centric programs and operational procedures.Effective...

  • Senior Claims Director of Severity

    7 days ago

    Atlanta, Georgia, United States AIG Full time

    About the RoleWe are seeking a highly skilled and experienced Complex Director of Claims Management to join our team at AIG. As a key member of our Claims organization, you will play a critical role in the investigation, evaluation, and disposition of complex claims.Key ResponsibilitiesDetermine the scope and extent of available coverage for complex...

  • Senior Claims Management Specialist

    2 weeks ago

    Atlanta, Georgia, United States RSUI Group Full time

    RSUI Group is seeking a highly skilled Senior Claims Management Specialist to oversee our Management Liability and Employment Practices Liability (EPL) claims division. This role is essential in delivering specialized expertise in the handling of complex claims. At RSUI Group, we foster a collaborative work environment that emphasizes the importance of...

  • Healthcare Claims Processing Specialist

    2 weeks ago

    Atlanta, Georgia, United States MultiPlan Full time

    Position Title: Medical Claims Intake Coordinator Work Arrangement: Remote - Temporary Compensation: $17.00 per hour Company Overview: Founded in 1980, MultiPlan stands as a leader in providing comprehensive healthcare cost management solutions. Our extensive portfolio assists payers in effectively managing healthcare expenses. Job Overview: We are looking...

  • Healthcare Claims Processing Specialist

    2 weeks ago

    Atlanta, Georgia, United States MultiPlan Full time

    Position Title: Medical Claims Intake Coordinator Work Arrangement: Remote - Temporary Role Compensation: $17.00 per hour About MultiPlan: Established in 1980, MultiPlan stands as a leading provider in healthcare cost management solutions. Our extensive portfolio aids payers in effectively managing healthcare expenses. Job Overview: We are looking for...

  • Healthcare Claims Processing Specialist

    2 weeks ago

    Atlanta, Georgia, United States MultiPlan Full time

    Position Title: Medical Claims Intake Coordinator Work Arrangement: Remote - Temporary Compensation: $17.00 per hour About MultiPlan: Established in 1980, MultiPlan stands as a leader in healthcare cost management solutions, offering a comprehensive array of services to assist payers in managing healthcare expenses. Job Overview: We are looking for several...

  • Senior Liability Claims Specialist

    2 weeks ago

    Atlanta, Georgia, United States General Placement Service Full time

    Job OverviewGeneral Placement Service is seeking a Senior Professional Liability Claims Adjuster to join our team in a hybrid capacity. This role is integral to our client, a leading Fortune 500 specialty insurance firm with a nationwide presence.Key Responsibilities:Overseeing professional liability claims, including Directors and Officers (D&O), Errors and...

  • Senior Liability Claims Specialist

    2 weeks ago

    Atlanta, Georgia, United States General Placement Service Full time

    Job OverviewGeneral Placement Service is actively searching for a Senior Professional Liability Claims Adjuster to operate in a hybrid work environment. Our client is a prominent Fortune 500 specialty insurance provider with a nationwide presence.Key Responsibilities:Overseeing professional liability claims, including Directors and Officers (D&O), Errors and...

  • Senior Liability Claims Specialist

    2 weeks ago

    Atlanta, Georgia, United States General Placement Service Full time

    Job OverviewGeneral Placement Service is seeking a Senior Professional Liability Claims Adjuster to operate in a hybrid work environment. Our client is a leading Fortune 500 specialty insurance firm with a nationwide presence.Key Responsibilities:Overseeing professional liability claims, including Directors and Officers (D&O), Errors and Omissions (E&O), and...