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Curative · 2 months ago

Claims Analyst

Austin, TX

Full-time

Onsite

New Grad, Entry Level

$25/hr - $27/hr

0+ years exp

Curative is reimagining health care and health insurance, and they are seeking a Claims Analyst to review claims for completeness and process per plan guidelines. This role involves maintaining compliance, confidentiality, and promoting the mission of the organization while meeting productivity and quality standards.

Health CareHealth DiagnosticsHealth InsuranceMedicalMedical DevicePersonal Health

Responsibilities

Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives

Documents clearly and concisely claims adjudication decisions in appropriate systems. Consults appropriate reference materials to verify proper coding

Ability to interpret and apply plan guidelines while processing to ensure correct plan setup

Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification

Proactively identify processes and system problems that can be improved, to reduce rework and provide accurate payment upon original processing

Maintains timely responses to appeals and reconsideration requests

Attends and participates in departmental training, functions, and meetings

Ability to meet/ maintain the required accuracy and production standards after release from training

Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures

Performs other duties, functions, and projects, as assigned, by team management

Qualification

Google SheetsExcelICD-10 codingCPT codingHCPCS codingHealthEdge Health Rule Payer SystemAnalytical skillsInterpersonal skillsProblem-solving skillsVerbal communication skillsWritten communication skills