Claims Analyst I

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $50k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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 clients’ claims adjudication systems, member and provider contracts, and claim payment policies and procedures • Assist clients in identifying, validating, and recovering claim overpayments • Validate claims for algorithm accuracy and verify that no refund was previously posted • Review and resolve disputed overpayments from clients or providers • Participate in knowledge sharing to resolve claim issues and seek clarifications • Identify new overpayment opportunities by researching CMS and Medicaid claims processing policies, client adjustments, claims policies and systems, and provider/member contracts • Ideate, test, document, and submit new overpayment trends and research scenarios • Research new ideas and follow the algorithm development process • Assist Management with concept approval information for client approval of specific trends • Represent TREND and its clients professionally • Cooperate with team members to meet goals and complete tasks efficiently • Provide Management feedback on inventory levels, algorithm effectiveness, productivity, and new trends or ideas • Collaborate with TREND Management to identify opportunities, improvements, and innovative solutions • Escalate situations outside the employee’s control that could adversely impact business relationships

🎯 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 • High School Diploma or Equivalent Required • Excellent computer skills and proficiency in Excel • Strong analytical skills • Strong communication and interpersonal skills • Attention to detail • Proven problem-solving abilities • Excellent written and oral communication skills • Effective organization and time management skills • Highly analytical, self-motivated, and directed • Ability to learn, understand, and apply new technologies • Experience with medical claims processing preferred • Experience identifying, analyzing, and recovering claim overpayments preferred

🏖️ Benefits

• Competitive salaries • Health insurance • 401(k) plan with employer match • Paid parental leave • Performance-based incentive program

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