Claims Analyst

2 weeks ago

Baltimore, United States Zolon Tech Inc. Full time

Job Description:

  • Primarily REMOTE, occasionally required onsite at the client's Baltimore, MD office.
  • Job Description Summary:
  • This role supports Utilization Management clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. Training will be onsite, and the candidate must be able to perform duties effectively after training.
  • Key Responsibilities:
  • Provide administrative support for member/provider tasks, including benefit verification, authorization management, and claims inquiries.
  • Review authorization requests and triage for clinical review.
  • Assist with general coordination, including answering calls, researching information, and resolving issues.
  • Support data tracking, reporting, and information dissemination, such as Continuity of Care and Peer-to-Peer reviews.

Qualifications:

  • Education: High School Diploma
  • Experience: 3 years in healthcare claims/service areas or office support
  • Preferred: Experience in managed care, knowledge of CPT and ICD-10 coding.

Skills Needed:

  • Strong communication, organizational, and customer service skills
  • Proficient in medical terminology, web-based technology, and Microsoft Office tools (Word, Excel, PowerPoint).

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