Associate Analyst, Claims Research (Remote)-Triage

UnitedHealth Group; United States; Remote; USD 20,000 - 44,000; Full time

Job summary

Molina Healthcare is seeking an entry-level claims analyst to support provider claims research and resolution. The role focuses on timely, accurate assessment of claims issues and leveraging knowledge of processing workflows to drive improvements.

You will contribute to meeting quality and production goals while documenting investigations and outcomes. The position emphasizes collaboration across teams, attention to detail, and strong communication skills to triage issues and support continuous

Qualifications

• 1+ year of experience in medical claims processing/research or health care operations.
• Basic medical claims processing knowledge.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills and ability to manage multiple tasks to meet deadlines.
• Customer service skills.
• Problem-solving skills.
• Ability to work independently and with cross-functional teams.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office, including Excel.

Responsibilities

• Reviews and analyzes claims-related issues to identify potential root-cause issues and triages for research or correction.
• Triages issues based on type and complexity, assigning to the appropriate department.
• Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.
• Meets quality and production goals.
• Maintains detailed records of claim reviews and resolutions.
• Identifies trends in submitted issues to inform process improvements.
• Provides feedback for process improvements related to provider claims research.

Skills

Data research and analysis

Customer service

Problem-solving

Time management

Organizational skills

Communication skills

Independent and cross-functional work

Microsoft Excel

Tools

Microsoft Excel

Job description

JOB DESCRIPTION Job SummaryProvides entry level analyst support for claims research activities. Ensures timely and accurate resolution of provider submitted claims issues/inquiries. Leverages understanding of medical claims processing and uses analytical skills to effectively triage issues to facilitate claims investigation or correction. Meets established production and quality standard. Identifies trends in claims issues to inform process improvements and drive continuous improvement in claims performance and compliance.

Essential Job Duties

• Reviews and analyzes claims-related issues submitted by providers to identify potential root-cause issues; triages issues quickly and accurately.
• Triages issues based on type and complexity, assigning to the appropriate department or team for further research or correction.
• Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate claims assessments.
• Meets quality and production goals.
• Maintains detailed records of claim reviews and resolutions.
• Identifies trends in submitted issues to inform process improvements and reduce recurring errors.
• Provides feedback and recommendations for process improvements related to provider claims research.

Required Qualifications

• At least 1 year of experience in medical claims processing/research and/or health care operations , or equivalent combination of relevant education and experience.
• Basic medical claims processing knowledge.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service skills.
• Problem-solving skills.
• Ability to work independently and as part of a team, and collaborate cross-functionally across a highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency.

Preferred Qualifications

• Experience with process improvement methodologies.
• Knowledge of industry regulations and compliance standards.
• Familiarity with systems used to manage claims inquiries and adjustment requests.
• Understanding of billing and coding procedures.
• Experience with Medicaid, Medicare, and Marketplace claims.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $14.76 - $31.97 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.