Senior Claims Analyst, Managed Care & Appeals

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

Job summary

University Health is seeking a Claims Reviewer to support efficient benefits adjudication and provider communications. The role focuses on reviewing and processing various claim types, including coordination of benefits and DME claims.

The ideal candidate has strong knowledge of medical terminology, ICD-9/CPT4 coding, and managed care principles, with at least five years of claim processing experience in HMO/PPO/ASO settings.

Qualifications

• High school diploma or GED equivalent.
• Five years HMO, PPO, ASO claim processing experience required.
• Thorough knowledge of medical terminology, ICD-9/CPT4 Coding, and general managed care principles.

Responsibilities

• Review, analyze, and adjudicate all claim types including COB and DME claims.
• Analyze provider appeals and document outcomes via correspondence.
• Act as provider liaison to resolve claim issues using corporate functionalities.

Skills

Medical terminology

Claims processing

Provider liaison

Education

High school diploma or GED

Job description

University Health is seeking a Claims Reviewer to support efficient benefits adjudication and provider communications. The role focuses on reviewing and processing various claim types, including coordination of benefits and DME claims.

The ideal candidate has strong knowledge of medical terminology, ICD-9/CPT4 coding, and managed care principles, with at least five years of claim processing experience in HMO/PPO/ASO settings.