The role of the Claims Analyst is to handle incoming healthcare claim inquiries, ensuring an elevated level of customer service, and maximize productivity by reviewing claims accurately for processing. The Claims Analyst will need to put their skills and talents along with our training to work as they review, research and advise how to process our provider’s medical claims. The Claims Analyst must be able to operate in a fast-paced environment, and be thoughtful, resourceful, collaborative, and customer focused.
Major Duties & Responsibilities:
- Review, research and analyze complex fertility related claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, CMS/Medicare guidelines)
- Complete daily reporting and communicate the status of claims adhering to claims inquiries
- Serve as a liaison between the medical providers and/or clients
- Communicate through correspondence with providers and/or clients regarding claim payment or required additional information for claims payment
Education and Job Experience:
- 4 years of experience in a health care environment. Knowledge of the fertility industry is strongly preferred.
- Undergraduate degree
- Demonstrated ability using all Microsoft applications, including strong keyboard and navigation skills, and capability to learn new programs.
- Ability to multi-task which includes understanding multiple insurance products and multiple levels of benefit within each product.
- Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology strongly preferred
- Ability to work independently and demonstrate good judgment
- Excellent interpersonal skills - ability to communicate accurately and concisely
- Highly organized, quick learner, with ability to multitask and prioritize work effectively
Special Skills, Abilities, and Requirements:
- Flexible and adaptable
- Demonstrated ability to collaborate with internal and external teams (e.g., finance, sales, technology and HR), external partners, and other stakeholders
- Creative problem solver with demonstrated ability to provide pragmatic legal solutions to complex business problem
As the leading fertility benefits company, we are committed to science and personalized care to provide a comprehensive and smart solution to self-insured employers. We’re currently supporting over 250,000 employees and have over 400 different clinic locations in our network. Our vision is to ensure anyone can have a child when they want.
- An amazing team of talented people who care about creating solutions to help others.
- Health, dental, vision and life insurance options for employees and family
- Paid vacation and summer flex time
- Company equity
- Friday lunches
- Our kitchen stocked with fresh fruit, drinks, and snacks