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Trend Health Partners · 1 month ago

Claims Analyst III (US Remote)

United States

Full-time

Remote

Mid, Senior Level

$70K/yr - $80K/yr

5+ years exp

TREND Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare. The Claims Analyst III is responsible for identifying, analyzing, and recovering claim overpayments for clients, which include commercial health insurance companies and state Healthcare programs, while ensuring accurate and timely completion of all related activities.

Health CareHospitalPayments

Responsibilities

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, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts

Interpret and analyze medical and pharmacy claims data as well as provider and enrollment data to accurately assess and demonstrate key insights into trends and opportunities and follow concept development process

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 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

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

Qualification

Claims analysisMedical terminologyExcel proficiencyAnalytical skillsProactive attitudeCommunication skillsInterpersonal skillsProblem-solving skills

Required

Bachelor's degree in accounting, business, healthcare, or a related field

Equivalent work experience in a similar position may be substituted for educational requirement

5+ years' experience in identification, analysis, 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