Claims Analyst

University-Health-3; San Antonio (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

Community First Health Plans in San Antonio seeks an experienced Claims Analyst for its Claims department. You will analyze complex issues related to claim payments, eligibility, and other insurance matters, including transplants, to support accurate adjudication.

The role requires a high school diploma or GED and at least five years of HMO/PPO claims experience; Amisys experience is preferred. You will work under limited supervision and collaborate with CFHP staff.

Qualifications

• High school diploma or GED is required.
• Five years HMO/PPO claims experience required.
• Amisys processing system experience preferred.

Responsibilities

• Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that affect claims payment.
• Act as consultant to claims staff in complex claim issue resolution.
• Work with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication.
• Promote harmonious relationships within CFHP and with other departments.
• Operate under limited supervision.

Skills

Claims experience

HMO/PPO knowledge

Problem solving

Education

High School Diploma or GED

5 years claims experience

Tools

Amisys claims processing system

Job description

We are looking for an experienced Claims Analyst for our Claims department with Community First Health Plans!

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.