| Part Time - Claims Analyst (Troy, MI)
Summary – The Part Time - Claims Analyst will be responsible for medical, dental, and vision claims processing of claims submitted electronically or on hard copy. Each Analyst will specialize in a particular group but is expected to handle claims processing for multiple groups. Applicants for this remote role will only be considered if they live in these locations: Arizona, Colorado, Washington DC, Iowa, Indiana, Kentucky, Maryland, Michigan, Missouri, Ohio, Wisconsin. Essential Duties and Responsibilities include but not limited to - Review claims for benefit determination based on exception reports of electronic claim submission or hard copy submissions.
- Make corrections when necessary to incorrect participant or provider data.
- Assist Client Services Representatives with difficult claim adjustments/corrections.
- Analyst must be able to determine benefits for multiple groups and process claims accurately according to the corresponding Plan Documents.
- Primary responsibilities will not include telephone or personal interaction with participants or providers unless; it is determined by a supervisor or manager that assistance is needed in this area.
- Regular and predictable attendance is an essential function of this job.
Claim Analyst Levels - Level I – Previous claims processing experience necessary. Must have working knowledge of medical terminology, CPT, ICD9/10, and HCPCS codes as well as CMS1500 and CMS1450 claim forms. Must be detail-oriented, work well independently and part of a team, self-motivated, possess analytical skills and ability to make benefit determinations utilizing plan documents. Must meet established productivity and quality expectations of 98% procedural and 99% payment/financial accuracy. Ability to process specialty claims such as flexible spending and HRAs.
- Level II – Must be proficient at all Level I skills. Complete understanding of claims processing system and assigned funds. Demonstrated ability to process all claim types and resolve complex claims including but not limited to Coalition and Hospitalist claims. Sound understanding of all aspects of the adjustment process. Ability to assist with system testing and claims auditing. Demonstrates initiative, sound judgment, and independent decision-making ability.
- Level III – Must be proficient at all Level I and II skills. Solid understanding of all claim types and the ability to assist on all funds. Ability to identify inconsistencies and escalate findings appropriately. Excellent communication skills. Ability to train and assist new hires as well as provide support for Analyst I and II’s. Conduct audits, report findings, provide detailed analysis of claims, and recommend changes for process improvement.
- Unit Lead - Must be proficient at all Level I - III skills. Must possess leadership ability and excellent communication skills both verbally and in writing. Demonstrates the ability to understand and facilitate the resolution of all complex claim issues including adjustments and appeals. Provide training to new hires and existing staff. Complete reporting for inventory, department, and individual analysts’ performance stats. Monitors inventory to ensure turn-around-times are maintained and department goals are achieved. Identifies error trends for training needs and works with the supervisor for implementation of processes to improve overall performance. Must demonstrate initiative, ability to multi-task and prioritize, and excellent organizational skills. Ability to represent the department on workgroups and new system implementation.
Qualifications - Individual must have previous medical claims processing experience and knowledgeable of medical terminology (i.e., CPT codes, ICD-9 codes, HCPCS, ADA codes). Analyst must be methodical and possess the skills to determine approval for benefit payment, versus pending or denying. Analyst will be accountable for benefit determinations. Excellent customer service skills are a must. Applicants for this remote role will only be considered if they live in these locations: Arizona, Colorado, Washington DC, Iowa, Indiana, Kentucky, Maryland, Michigan, Missouri, Ohio, Wisconsin. Education and/or Experience - High School diploma or GED equivalent and two years related experience. Language Skills - Ability to read and interpret documents such as Summary Plan Descriptions of Plan rules. Ability to communicate professionally and clearly with other departments of BeneSys. Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication and division. Reasoning Ability - Ability to apply common sense to carry out detailed written or oral instructions. Work Schedule Part-time, less than 30 hours a week Monday – Friday, 5 - 6 hours a day Permanent Remote position (No in-office days) Competitive Benefits and Compensation Package - Paid Time Off (PTO) - Pro-rated based on work schedule
- Holiday Pay – Pro-rated based on work schedule
- 401k with employer match
- Career development opportunities
- Referral bonus for all successful full-time referrals
Pay - Hourly rate is $21.00. Actual rate dependent on location, skills, education, experience and other business factors. Our Culture BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values: - Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
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