Healthcare Account Analyst

bizjobz LLC; Bethesda (MD); On-site; USD 80,000 - 110,000; Full time

Job summary

Our client, a physician-owned MSO, seeks a Healthcare Account Analyst to partner with and work under the direction of the VP of Human Resources. This remote/hybrid role analyzes and processes complex health insurance claims, focusing on Stop Loss and client support.

Responsibilities include processing high-dollar claims, ensuring policy compliance, communicating with TPAs, brokers and clients, monitoring discrepancies, and generating reports to aid client evaluations.

Qualifications

• 5+ years in health insurance claims, 3+ years in claims processing and Stop Loss roles.
• Experience with medical terminology, WEX, and benefits reporting tools.
• Strong communication skills and proficiency in Excel and Power BI.
• Preferred: Bachelor’s degree and relevant industry experience.

Responsibilities

• Process and evaluate incoming claims, including high-dollar and aggregated Stop Loss claims.
• Ensure compliance with policies, regulations, and industry standards.
• Communicate with TPAs, brokers, and clients, providing guidance and support.
• Monitor claims for discrepancies, trends, and loss control, involving relevant departments as needed.
• Maintain accurate records, generate reports, and assist in client performance evaluations.

Skills

Health insurance claims

Communication skills

Excel

Power BI

Medical terminology

Education

Bachelor’s degree (preferred)

Tools

WEX

Benefits reporting tools

Job description

Our client is a leading, physician-owned, next-generation Management Services Organization (MSO) supporting one of the most respected and expansive multi-state independent physician practices in the Mid-Atlantic region, as well as additional healthcare clients nationwide.

The organization is seeking a Healthcare Account Analyst to partner closely with and work under the direction of the Vice President of Human Resources. This position can be in office/hybrid/ or

REMOTE

This role involves analyzing and processing complex health insurance claims, focusing on Stop Loss, client support, and report management.

Key Responsibilities

• Process and evaluate incoming claims, including high-dollar and aggregated Stop Loss claims.
• Ensure compliance with policies, regulations, and industry standards.
• Communicate with TPAs, brokers, and clients, providing guidance and support.
• Monitor claims for discrepancies, trends, and loss control, involving relevant departments as needed.
• Maintain accurate records, generate reports, and assist in client performance evaluations.

Qualifications

• 5+ years in health insurance claims, 3+ years in claims processing and Stop Loss roles.
• Experience with medical terminology, WEX, and benefits reporting tools.
• Strong communication skills and proficiency in Excel and Power BI.
• Preferred: Bachelor’s degree and relevant industry experience.