What are the responsibilities and job description for the CLAIMS ANALYST position at BC&L INC?
Job Responsibilities
As a Medical Claims Analyst you’ll be responsible for determining eligibility of claims under major medical and self-insured plans, investigating charges, explaining payment or denials to claimants, and more.
Key responsibilities may include:
- Communicates internally & externally with clients, participants, brokers, agents, & more
- Analyzes claims to determine eligibility, medical facts, contract coverage & limitations
- Determines when to pay or deny claims, or request additional information
- Calculates payment of benefits in accordance with coverage information, contract language or plan document & medical documentation
- Screens all charges for reasonableness of costs & medical necessity
- Investigates excess or questionable charges by letter or telephone
- Determines possibility of coordination of benefits (COB) on each claim & calculates benefits accordingly
- Coordinates with member advocates to contact providers, members, and others in regard to claims, additional information, eligibility, and additional issues affecting claims adjudication
- Participates in continuous process improvement efforts, training junior team members, or offering insight on workflow enhancements.
- Provides insight or feedback on complex claim scenarios, escalations, or appeals requiring advanced plan interpretation.
- Additional responsibilities as assigned based on client and business needs
What We’re Looking For (Nobody’s Perfect, But Experience is a Plus!)
- High school diploma or equivalent
- Minimum of 3 years of direct experience processing or reviewing medical claims, preferably in a TPA, insurance carrier, or healthcare setting
- Experience & education may be substituted when equivalent, but direct experience is strongly preferred for this role
- Knowledge of CPT, HCPCS, IC10 coding
- Knowledge of claims processing & the Eldorado system (preferred)
- Skilled in customer service, with strong communication skills (interpersonal & written)
- Good at problem solving and analyzing information
- Comfortable with software and technology and willing to learn new systems
- Able to adapt to a constantly changing environment & multitask
- Able to accurately compile data, perform detailed work & maintain confidential information
- Able to meet deadlines
- Able to maintain attendance & present a professional appearance & demeanor
- Able to work well with others
Salary : $17 - $18