Claims Analyst

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Handles difficult situations and acts with appropriate level of urgency when necessary.

Follows precise instructions when processing claims.

Completes assigned work and maintains production and quality standards.

Extensively collaborates cross-functionally to support resolution of claim issues.

Researches and resolves adjustment inquiries.

Performs edit resolutions from pended paper and electronic claims using critical sense of urgency and sound judgement for accurate claims processing.

Works complicated reports, which involves critical resolutions on adjustments, overrides of copayments, coinsurance, correct pricing and provider selection.

Performs side by side comparisons to validate corrected claim actions.

Issues letters & forms when appropriate.

Performs initial overpayment recoupment process in the overpayment application.

QualificationsHigh school diploma or general education degree (GED)

1+ years of experience in a related role

Basic knowledge and understanding in operational processes and complicated pricing calculations for medical/hospital claims processing

Demonstrated experience researching and understanding moderately complex information (such as government regulations, contracts, etc.), as well as solving ambiguous problems

Strong attention to detail

Ability to work in a fast-paced environment with multiple high priorities

Flexibility and adaptability to frequently changing guidelines and processes

Ability to learn and maintain knowledge of medical benefits and how they are administered and Medicare fee schedules, as well as Federal, State, and local healthcare regulations

Collaboration skills and the ability to communicate effectively through both written and verbal modalities

Proficiency with business applications like Microsoft Office Suite

Experience working with 10-key and excellent keyboarding skills

Critical thinking, problem-solving, and investigatory skills

Preferred QualificationsExperience in Claim Processing is a plus

Bachelor's degree preferred

Working ConditionsWhile performing the duties of this job, the employee works in normal office working conditions.

DisclaimerThe job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.Location:MissouriTime Type:Full time