Medical Claims Analyst
4 weeks ago
**Job Summary**:
The Claims Analyst will provide timely and accurate processing and adjudication of claims. The role will research, and process claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare options. The client is internationally based, so after-hours work, aligned with the client’s business hours in their country, will be required. This is a fixed-term role with the potential for permanent employment, based on the client’s ongoing needs.
**Duties and Responsibilities**
- Work from a queue to review assigned claims or requests at a set inventory level.
- Examine claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract and/or policy.
- Perform rework, med review, or other projects as assigned.
- Identify and report adjudication inaccuracies that are related to system configuration, benefit inconsistency, and fee schedules.
- Efficiently and accurately analyze medical claims to determine whether or not the claim should be approved or denied for payment in accord with the plan / client conditions.
- Resolve pended healthcare claims and prior approval requests.
- Assist other departments by working on projects and or providing feedback, research, and resolution to inquiries regarding claims adjudication.
- Achieve and exceed key performance indicators for performance, production, and quality.
- Develop in role, team and organization through active participation in knowledge transfer and support of engagement and initiatives.
**Required Skills, Knowledge, and Abilities**
- High School Diploma or equivalent. Bachelor’s degree preferred or experience in lieu of degree
- 2 years of medical claims processing including knowledge of medical terminology and working in a production environment
- Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
- Communicate clearly and professionally with internal and external customer
Work overtime as required, including weekends
**Job Types**: Full-time, Temp to perm
Pay: R12 000,00 - R20 000,00 per month
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