Claims Analyst III

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $70k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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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

• Identify, analyze, validate, and recover claim overpayments for commercial health insurance companies and state healthcare programs • Research claims, systems, documents, CMS and Medicaid claims-processing policies, client policies, provider and member contracts, and related data • Validate claims and algorithms, ensuring no refunds were previously posted • Review and resolve disputed overpayments from clients and providers • Identify new overpayment opportunities and trends • Analyze medical, pharmacy claims, provider, and enrollment data to assess trends and opportunities • Assist management with concept approval information • Complete step-by-step instructions for algorithms moved to production • Provide feedback on inventory levels, algorithm effectiveness, productivity, and new trends • Collaborate with management to identify opportunities and improvements • Escalate issues that may adversely impact business relationships • Train and assist new analysts • Assist with the Quality Review process • Resolve day-to-day problems in a timely manner

🎯 Requirements

• Bachelor’s degree in accounting, business, healthcare, or a related field • Equivalent work experience in a similar position may be substituted for educational requirement • Experience in identification, auditing, and recovery of claim overpayments • Strong understanding of calculations and medical terminology • Excellent computer skills and proficiency in Excel • Strong analytical and problem-solving skills • Strong communication and interpersonal skills • Ability to connect and build relationships with providers, management, and peers • Proactive, independent, and results-oriented • Customer- and team-focused • Willingness to complete compliance requirements, including background and drug screenings and disclosures of personal health information or personally identifiable information

🏖️ Benefits

• Competitive salaries • Health insurance • 401(k) plan with employer match • Paid parental leave • Collaborative and innovative work environment