The Health Plan (THP) · 1 month ago
Claims Analyst
Charleston, WV, US
Full-time
Onsite
New Grad, Entry LevelThe Health Plan (THP) is a healthcare organization seeking a Claims Analyst to perform initial reviews of claims. The role involves ensuring compliance with production and quality standards while following established policies and procedures.
Health CareInsuranceNon ProfitWellness
Responsibilities
Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan
Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines
Reports patterns of incorrect billing and utilization to manager or claims coordinator
Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines
Maintain a quality rating of 98%
Processes 15-20 claims per hour
Consistently displays a positive attitude and acceptable attendance
Participate in external and/or internal trainings as requested
Qualification
Required
High school diploma or equivalent
Ability to follow written directions and work independently
Familiarity with medical terminology, CPT and ICD-10 coding is required
Computer and typing experience is required
Preferred
Previous claims processing
Experience in billing or physician office experience is preferred
Company
The Health Plan (THP)
The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.
Founded in 1979
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ryan J. Ralston
Chief Financial Officer
Bob Roset
Senior Vice President, Information Systems (CIO)
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