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Magellan Health · 1 month ago

Claims Resolution Analyst

United States

Full-time

Remote

Senior Level

$46K/yr - $68K/yr

5+ years exp

Magellan Health is a healthcare organization focused on providing effective solutions for health plans. The Claims Resolution Analyst is responsible for coordinating the resolution of claims issues by researching and analyzing systems and processes across operational areas to ensure timely and accurate claims processing.

BiotechnologyHealth CareHospital

Responsibilities

Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing

Identifies the interdependencies of the resolution of claims errors on other activities within operations

Assists in the reviews of state or federal complaints related to claims

Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines

Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved

Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues

Qualification

Claims experienceComplex claims researchIssue resolutionReimbursement methodologiesAnalytical skillsTeam coordinationCommunication skills

Required

Requires a BA or BS

5-7 years' claims experience

Minimum 1 year experience of complex claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry

Any combination of education and experience which would provide an equivalent background may be considered