Lead Claims Analyst

Company Name:
## Description
Position Purpose:
Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues
Position Responsibilities:
Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims
Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
Assist in creating work flows for the department and support team members in understanding changes in work processes
Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues.
Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.
Maintains records and reports as assigned
Assist in meeting departmental production and quality standards
May process claims when needed
## Qualifications
High school diploma or equivalent. 2+ years of claims processing, medical billing, administrative, customer service, call center, or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology. Experience with Medicaid or Medicare claims preferred.
## Job
Job: Claims
Primary Location: USA-Montana-Great Falls
Other Locations: USA-Centene-Centene
Organization: Claims - Montana
Schedule: Full-time
Req ID: 006IF

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