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Highmark · 4 weeks ago

Benefit and Claims Analyst

Erie-Meadville Area

Full-time

Onsite

Mid Level

$21.53/hr - $32.30/hr

3+ years exp

Highmark Inc. is seeking a Benefit and Claims Analyst who will coordinate, analyze, and interpret benefits and claims processes for clinical teams while serving as a liaison between various departments. The role requires a thorough understanding of product offerings and claims payment methodologies to effectively support customer inquiries and manage complex claims.

Health CareHealth InsuranceInsuranceWellness

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

Claims payment methodologiesBenefits administrationHighmark products knowledgeCustomer service experienceICD9CPTHPCPS codingMulti-tasking abilityEffective communicationProblem-solving 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