Claims Analyst

Curative - Austin, TX

Full-time

Austin, TX

Personal and Laundry Services

About the position

The Claims Analyst position at Curative involves reviewing claims for completeness and processing them according to established plan guidelines. The role emphasizes compliance, confidentiality, and the organization's mission, requiring the analyst to make adjudication decisions, document claims accurately, and coordinate with various stakeholders to ensure proper claim handling.

Responsibilities

• Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives.
• Documents clearly and concisely claims adjudication decisions in Claim Notes.
• Consults appropriate reference materials to verify proper coding.
• Interprets and applies plan guidelines while processing to ensure correct plan setup.
• Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification.
• Proactively identifies processes and system problems that can be improved to reduce rework and provide accurate payment upon original processing.
• Maintains timely responses to appeals and reconsideration requests.
• Attends and participates in departmental training, functions, and meetings.
• Meets and maintains the required accuracy and production standards after release from training.
• Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures.
• Performs other duties, functions, and projects as assigned by team management.

Requirements

• At least 3-5 years of experience in claims adjudication, including PPO and/or Medicaid, ERISA, Medicare, Level Funded and Self-Funded Experience with various claim payment systems.
• Excellent working knowledge of MS Access, Google Sheets, and Excel required.
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
• Experience processing claims on the HealthEdge System is preferred.
• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent interpersonal and problem-solving skills.
• Excellent verbal and written communication skills to communicate clearly and effectively to all levels of staff, members, and providers.
• Ability to be focused and sit for extended periods of time at a computer workstation.
• Ability to work in a team environment and manage competing priorities.
• Ability to calculate allowable amounts such as discounts, interest, and percentages.

Nice-to-haves

• Experience processing claims on the HealthEdge System is preferred.