Responsibilities:

The Research Analyst is responsible for researching, analyzing and resolving projects or correspondence submitted by plans, providers and/or other stakeholders.

• Functions as Subject Matter Expert (SME) for Claims department.
• Analyzes complex operational claim payment problems and provides technical solutions.
• Identifies and recommends process improvement changes to existing processes and procedures which result in more efficient practices.
• Provides support to operations based on business needs.
• Responds to written providers’ inquiries.
• Maintains a current working knowledge of processing rules, contractual guidelines, plan policies and operational procedures to effectively provide technical expertise.
• Provides feedback regarding Online Help discrepancies and reports them to the Team Lead Educator.
• Provides technical and peer training as requested.
• Maintains accurate personal production records.
• Escalates claim and/or system issues to Team Lead or Supervisor.
• Completes provider correspondence and service forms as required.
• Creates and supports a professional environment which fosters teamwork, cooperation, respect and diversity.
• Meet department quality and production requirements
• This position is required to meet and maintain performance goals established for the position in the areas of quality and production.
• Process claims for multiple Line of Business as requested by management
• Understands processing rules for multiple lines of business and supports other lines of business as needed to meet business needs.

Education/Experience:

• 2 to 3 years claims processing experience.
• High School/GED required.
• Associate’s Degree preferred.
• In-depth knowledge of claims payment methodology.
• Excellent research and analytical skills.
• Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and leaning new computer programs.
• Ability to research and investigate information using multiple sources and documented guidelines.
• Ability to track and follow up on multiple projects.