Claims Analyst I

🕒 vor 10 Tagen

Jetzt Bewerben

Ähnliche Remote-Jobs finden

E-Mails für Remote-Jobs erhalten

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen

Trend Health Partners

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 2018

⚕️ Krankenversicherung

💳 Fintech

🤖 Künstliche Intelligenz

💰 Private Equity Round im 2023-01

Healthcare Insurance • Fintech • Artificial Intelligence

<Trend Health Partners> ist ein Unternehmen für Gesundheitstechnologie, das eine KI-gestützte Kollaborationsplattform bietet, um die finanziellen Interaktionen zwischen Kostenträgern und Leistungserbringern zu verbessern. Das Unternehmen bietet Lösungen für Zahlungsintegrität, Ablehnungsmanagement und Salden-/Überzahlungsauflösung durch seine TREND Connect-Plattform und Tools wie CAVO® an. Es positioniert sich als unabhängiger neutraler Partner, der Krankenhäusern und Krankenkassen hilft, Kosten zu senken, die Zahlungsgenauigkeit zu verbessern und die Schadensregulierung zu optimieren.

Beschreibung

• 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.

🎯 Anforderungen

• 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

🏖️ Vorteile

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