Claims Operations Analyst

Company: Integrated Resources, Inc
Location: Newark
Posted on: January 14, 2021

Job Description:

Title: Claims Operations AnalystLocation:--Newark,--NJDuration: 12+ monthsJob Description1. Review and investigate high dollar and escalated claim related issues. Work with leadership team and other support areas to resolve issues and coordinate responses to the appropriate internal or external areas.2. Assist with internal and external audits by conducting sample reviews and creating action plans resultingfrom CMS, DOBI, OPM, Quality, MTM , PG and ASO related situations.3. Request and review reports to identify and monitor claim trends and utilize data to support findings andresolutions.4. Participate in various internal and external project workgroups and will take the lead in coordinating theresolution of user or technical issues.5. Serve as SME for Claims Team, facilitate periodic workflow review sessions and attend team meetings tocommunicate trends and resolutions.6. May support User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements,etc.7. Perform other relevant tasks as assigned by management.Compliance Statement:Demonstrates knowledge and understanding of the laws, regulations and policies that pertain to the organizational unit's business and conforms with these laws, regulations and policies in carrying out the accountabilities of the job.Additional Job DescriptionEducation/Experience:- High School Diploma or GED equivalent required.- Three (3) years of experience processing and adjusting medical claims in NASCO preferred.- Minimum of four (4) years' experience in an operational role, or analytical role.Knowledge:- Knowledge of Client Client Cross programs, products and procedures preferred.- Knowledge of Professional and Facility reimbursement practices and principles preferred.- Requires knowledge of MS Excel, PowerPoint, and Word.- Knowledge of SharePoint preferred.Skills and Abilities:- Requires strong analytical and investigational skills.- Requires strong oral and written communications skills.- Requires strong interpersonal skills and the ability to interface with internal and external customers.

Keywords: Integrated Resources, Inc, Newark , Claims Operations Analyst, Professions , Newark, New Jersey