Claims Business Analyst for Medicare Advantage

3 weeks ago


Charlottesville, Virginia, United States CommuniCare Corporate Full time

At CommuniCare Corporate, we are seeking a skilled Claims Business Analyst to join our team. This fully remote position will involve reviewing and auditing medical claims, identifying inaccuracies in processing, and providing input on solutions.

Key Responsibilities:

  • Effectively review and audit medical claims to ensure accuracy and compliance with Medicare regulations
  • Monitor claims trends to identify configuration and payment errors
  • Analyze report results to pinpoint trends and correlations in complicated data sets
  • Research and interpret Medicare claim processing regulations and requirements
  • Develop automated routines for extracting claims data

Requirements:

  • Bachelor's degree in business, health care administration, or similar; or at least 2 years of experience working in health insurance field
  • 2 years of experience with government health insurance (Medicare, Medicare Advantage, Medicaid) preferred
  • Health insurance plan claim processing experience (adjudication, audit, review)
  • Claim appeal experience preferred
  • SQL familiarity and ability to run basic queries

What We Offer:

  • Competitive wages and PTO plans
  • Full-time employees enjoy a menu of benefit options, including life and disability plans, medical, dental, and vision coverage, and 401(k) with employer match

We are committed to providing a collaborative and dynamic work environment that fosters growth and development. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.



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