
Claims Account Analyst
21 hours ago
Overview
Claims Account Analyst is responsible for evaluating claims to ensure they are accurate and processed in a timely manner. They review and assess the validity of claims based on the policy guidelines. They also follow precise procedures in managing high-volume claims according to department goals and deadlines.
Responsibilities- Evaluate all claims for accuracy and completeness of documentation.
- Review, investigate and determine the validity of claims based on the policy guidelines.
- Process electronic spreadsheets and paper claims submitted by service network-providers in appropriate payment module.
- Adjudicate claims based on appropriate underwriter and client’s specific business rules.
- Respond to claim inquiries from both customers and internal stakeholders.
- Resolve discrepancies or issues with claims.
- Raise system issues effectively to the proper department.
- Ensure shared mailbox is being managed well and queries are attended promptly.
- Issue clear, effective, and accurate communications to internal and external customers.
- Conduct all interactions with internal and external customers in a positive and professional manner.
- Report problems and provide alternate solutions to Supervisor.
- Performs ad hoc activities and tasks as required.
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Medical Claims Analyst
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