Senior Health Claims Analyst & Process Lead

Driscoll Health Plan; Corpus Christi (TX); Sur place; USD 65 000 - 90 000; Plein temps

Résumé du poste

Driscoll Health Plan in Corpus Christi, TX is seeking a Senior Claims Analyst to perform complex claims analysis, research, and recovery work. You will collaborate with Claims Administration and health plan partners to resolve issues, lead projects, and improve processes while ensuring data integrity and compliance.

Ideal candidates have at least five years in claims analysis or medical billing with Texas Medicaid experience, plus two years in claim research and recovery.

Qualifications

• Minimum five years professional experience in claims analysis, provider medical billing, or medical coding experience with Texas Medicaid preferred.
• Minimum two years professional experience with claim research, adjustment and recover; Texas Medicaid preferred.
• Minimum High school graduate or GED required.

Responsabilités

• Analyze highly complex claims and claim issues to ensure correct claims payment and resolution with partners.
• Identify trends and recommend solutions for errors identified during claim review.
• Assist leadership to develop daily inventory plans based on resources and timelines.
• Analyze provider correspondence to determine outcomes and escalate high-priority issues.
• Lead departmental projects and operational improvement initiatives.
• Ensure data integrity, security, and process Optimizations in operations.
• Maintain privacy and confidentiality in compliance with policies.

Connaissances

Claims analysis

Leadership

Project coordination

Data integrity

Regulatory compliance

Mentoring/coaching

Formation

High school diploma or GED

Description du poste

Driscoll Health Plan in Corpus Christi, TX is seeking a Senior Claims Analyst to perform complex claims analysis, research, and recovery work. You will collaborate with Claims Administration and health plan partners to resolve issues, lead projects, and improve processes while ensuring data integrity and compliance.

Ideal candidates have at least five years in claims analysis or medical billing with Texas Medicaid experience, plus two years in claim research and recovery.