Senior Claims Analyst & Adjudication Expert

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

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.