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  Claims Analyst  
 

Brief Description of Duties

The position of "Claims Analyst" is performed at a workstation, on a personal computer, the majority of the working day. There is minimal internal or external customer interaction. Scheduled hours are based on business need and management approval. Business hours are from 8:00 a.m. to 5:00 p.m. (EST).

Job Summary:

Responsible for entering healthcare claim data timely and efficiently into HMIS (Health Management Information System) according to network repricing guidelines and other AHG protocols.

Essential Functions of the Job:

  • Ensure that the expectations of American Health Groups clients (and their employees) are consistently met and/or exceeded - by providing consistent quality and professional services to all internal and external customers.
  • Maintain the screening, organizing, sorting, and entry of healthcare claims received (according to network and branch specifications) in an efficient, timely, and accurate manner.
  • Learn, know, and understand the network repricing expectations.
  • Follow all verbal and written policies.

Minimum Qualifications or Equivalents:

  • Ability to work at workstation (on a computer) the majority of the working day, with or without reasonable accommodations.
  • Bachelors degree preferred, or equivalent years of experience.
  • Minimum of two years professional work experience preferred.
  • Knowledge and experience on a personal computer, with full understanding of keyboard skills (Microsoft Windows-based environment).
  • Ability to be flexible with hours worked for training and overtime requirements.
  • Ability to establish goals, handle and resolve recurring problems, work toward team and individual goals - all with general supervision.
  • Demonstrated "attention to detail" skills with a commitment to quality required.
  • Demonstrated problem-solving and organizational skills required.
  • Demonstrated oral and written communication skills preferred.
  • Ability to maintain confidential information required.

(Disclaimer: This job description is not all-inclusive. A complete job description will be given at the time of employment.)

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