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Medical Claims Analyst

Company: ActiveSoft, Inc
Location: Boston
Posted on: January 16, 2022

Job Description:

Boston, MA

Full time
Claims analysis and resolution
Provides cross functional support to key Operations projects as needed.
Assists Manager with review and analysis of weekly Claims Dashboard. Ensuring claims inventory is current.
Identifies patterns within Claims inventory and works with Claims leadership and Claims TPA to resolve.
Leads provider calls as Claims SME
Works with Claims TPA on provider appeals
Works with CCA technical staff to help design/develop claims payment rules.
Works with team, management, and self-directed to identify and document benefits, costs and risks associated with business decisions.
Has a strong customer services focus and communicates status issues and changes to appropriate audience.

Required :
Bachelor's Degree or equivalent experience
3 plus years of Claims experience
Advanced Excel skills
3 plus years of Medicare Advantage Experience
Medicare/ Medicaid working knowledge
SQL, Tableau, PowerPoint, OneNote experience
3rd party vendor experience

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Keywords: ActiveSoft, Inc, Boston , Medical Claims Analyst, Healthcare , Boston, Massachusetts

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