Claims Analyst

University Health; San Antonio (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

CFHP is seeking a qualified claims analyst to analyze complex problems affecting claim payments, eligibility and other insurance issues. You will act as a consultant to claims staff for complex adjudication and collaborate with Configuration in testing contracts used in business operations.

With five years of HMO/PPO claims experience and knowledge of CFHP benefits, Medicaid, HMO, PPO and ASO, you will operate with limited supervision and promote harmonious interdepartmental relationships.

Qualifications

• High school diploma or GED required.
• Five years HMO/PPO claims experience required.
• Amisys claims processing system experience preferred.
• Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.

Responsibilities

• Analyze complex problems affecting claims payments and eligibility.
• Consult claims staff on complex claim issue resolution.
• Test contracts with Configuration to assure auto adjudication.
• Promote harmonious relationships within own department and across other departments.
• Operate under limited supervision.

Job description

POSITION SUMMARY/RESPONSIBILITIES

Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision.

EDUCATION/EXPERIENCE

High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.