Geisinger · 12 hours ago
Claims Investigation Analyst I
Danville, PA
Full-time
Onsite
Mid Level
4+ years expGeisinger is a healthcare organization that is seeking a Claims Investigation Analyst I to review and resolve complex claims issues. The role involves acting as a liaison between providers and Health Plan departments, ensuring accurate claims processing and facilitating the exchange of information to improve provider satisfaction.
Health CareHospitalMedical
Responsibilities
Acts as the technical claims expert, following state and federal guidelines and provider contracts
Educates contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer and available resources such as provider manuals, websites, fee schedules, etc
Provides on-site professional guidance as needed to facilitate issue resolution
Evaluates and resolves complex claim and provider billing issues in a timely manner and according to set standards
Coordinates with the provider, as needed, in alignment with the Account Management team, on claims processing issues and provides follow-up to all impacted parties
Works with the customer service team to ensure accurate interpretation of billing guidelines, member benefits, contract terms, exclusions and limitations; escalates as necessary
Interfaces with the call center to compile, analyze and disseminate information from provider calls
Provides feedback to the configuration team to ensure payment terms are set-up correctly
Assists with completion of claims audits to ensure accurate payments to providers
Responds to provider inquiries regarding claims payments
Communicates with providers to gain feedback regarding the extent to which providers are informed about appropriate claims submission practices
Provides information and facilitates and coordinates appropriate resolution of issues and complaints
Documents inquiries, complaints and other data in all applicable systems in an accurate, clear and timely manner
Identifies trends and develops ways to streamline and simplify internal processes as necessary to reduce turnaround times and improve data quality and provider satisfaction
Initiates process improvement projects resulting from operational concerns
Qualification
Required
High School Diploma or Equivalent (GED)- (Required)
Minimum of 4 years-Relevant experience (Required)
Benefits
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
Company
Geisinger
Geisinger is a health and wellness organization that offers orthopaedic, weight-management, and heart care services. It is a sub-organization of Risant Health.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.95MKey Investors
U.S. Department of Agriculture
2024-04-02Acquired
2024-01-10Grant· $0.95M
Leadership Team
Terry Gilliland
President & CEO
Anne Morse
Director, Division of Pediatric Sleep Medicine
Recent News
EIN Presswire
2025-12-08
2025-11-23
2025-11-03
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