Claims Analyst III

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

💰 Private Equity Round on 2023-01

Healthcare Insurance • Fintech • Artificial Intelligence

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

• 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 and resolve claim issues or seek clarifications. • Identify new overpayment opportunities and trends by reviewing and researching areas such as CMS and Medicaid claims processing policies. • Interpret and analyze medical and pharmacy claims data as well as provider and enrollment data. • Assist Management with concept approval information needed for client approval on specific trends. • Complete step by step instructions for each algorithm moved to production. • 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 trends/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. • Train and assist new analysts as needed while maintaining high quality and production results. • Assist with Quality Review process. • Ensure staff is appropriately resolving day-to-day problems in a timely and successful 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 proficient in Excel • Strong analytical and problem-solving skills • Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with providers, management, and peers

🏖️ Benefits

• Competitive salaries • Highly valued health insurance • 401(k) plan with employer match • Paid parental leave • More.