What are the responsibilities and job description for the Remote-Medical Claims Analyst position at Boon-Chapman?
ABOUT YOU
You thrive in a fast-paced environment. You’re curious and have an eye for detail. You strive to exceed expectations, and succeed. You’re excited by the opportunity to join a fast-growing company with unlimited opportunities for growth & competitive benefits. Does this sound like you? If so, Boon-Chapman could be the place for you!
ABOUT US
Boon-Chapman is not your average Third Party Administrator. In addition to traditional TPA services, Boon-Chapman administers business process outsourcing for insurance entities, and other services through its sister companies. With nearly 55 years in business, Boon-Chapman combines the legacy of a family-owned-and-operated company, with the energy and potential of a fast-growing enterprise of companies. A few of our benefits include:
- Paid holidays & competitive PTO that increases with tenure
- Full benefits package including healthcare, dental, vision, paid STD & life
- Casual everyday dress
- 401K benefits
- Unlimited opportunities for growth – success is in your own hands
JOB RESPONSIBILITIES
The Medical Claims Processor will analyzes medical claims submitted under fully-insured or self-insured plans and determines eligibility of claims for The Boon Insight Team’s clients. The Claims Analyst reports to the Boon Insight Team Claims Operations Manager.
- Analyzes claims to determine eligibility, medical facts, contract coverage and limitations.
- Determines when to pay, deny or request additional information when handling claims.
- Calculates payment of benefits in accordance with coverage information, contract language or plan document and medical documentation.
- Utilizes understanding of medical claims administrative guidelines as well as insurance contract provisions.
- Screens all charges for reasonableness of costs, questionable charges and medical necessity when appropriate.
- Determines possibility of coordination of benefits (COB) on each claim and calculates benefits accordingly.
- Investigates claims by contacting doctors, hospitals and other providers.
- Corresponds with claimants, health care providers, and other interested parties to explain payment of benefits, denials, and delay in payments.
- Meets monthly quality, production and attendance metrics.
- Performs other duties as assigned
WHAT WE'RE LOOKING FOR (NOBODY'S PERFECT BUT EXPERIENCE IS A PLUS)
- High school diploma or equivalent
- Experience & education may be substituted for one another
- Knowledge of CPT, HCPCS, IC9 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
- 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