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Highmark Health · 1 month ago

Benefit and Claims Analyst

United States

Full-time

Remote

Mid Level

$21.53/hr - $32.30/hr

3+ years exp

Highmark Inc. is a health insurance company looking for a Benefit and Claims Analyst. The role involves coordinating and analyzing benefits and claims processes, serving as a liaison between departments, and providing technical guidance on claims.

Health CareHospital

Responsibilities

Coordinate, analyze, and interpret the benefits and claims processes for the department

Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties

Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations

Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes

Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines

Monitor and identify claim processing inaccuracies. Bring trends to the attention of management

Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication

Work independently of support, frequently utilizing resources to resolve customer inquiries

Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants

Gather information and develop presentation/training materials for support and education

Other duties as assigned or requested

Qualification

Health insurance claims experienceHighmark productsICD9CPTHPCPS codingMicrosoft Office proficiencyMedical procedures knowledgeCustomer service principlesAdministrative procedures knowledgeProblem-solving abilityEffective communication skills

Required

High School or GED

3 years of customer service, health insurance benefits and claims experience

Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies

PC Proficiency including Microsoft Office Products

Ability to communicate effectively in both verbal and written form with all levels of employees