Claims Analyst I

🕒 May 29

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2023-01

Healthcare • Healthcare Insurance • Fintech

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures. • Assist client in identifying, validating, and recovering claim overpayments. • Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s) • Review and resolve disputed overpayments from client/provider. • Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications. • Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts. • Ideate, test, document & submit new overpayment trends/research scenarios. • Research potential new ideas and follow algorithm development process. • Assist Management with concept approval information needed for client approval on specific trends. • Always represent TREND and our clients in a professional manner • Cooperate with team members to meet goals and complete tasks in an efficient and effective manner. • Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas. • Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions. • Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.

🎯 Requirements

• Bachelor’s degree in accounting, business, healthcare, or a related field. Equivalent work experience in a similar position may be substituted for educational requirements. • Excellent computer skills and proficient in Excel • Strong analytical skills • Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers. • Attention to detail. • Proven problem-solving abilities. • Excellent written and oral communication skills • Effective organization, time management skills • Highly analytical, self-motivated, and directed • Must be able to learn, understand, and apply new technologies. • High School Diploma or Equivalent Required

🏖️ Benefits

• competitive salaries • highly valued health insurance • a 401(k) plan with employer match • paid parental leave