Welcome to Montage Health’s application process!

Job Description:

The Claims Analyst is responsible for processing and analyzing health insurance claims, reviewing eligibility, interpreting and applying plan requirements and responding to claim inquiries from both internal and external stakeholders.

Responsibilities

• Process medical, dental, and vision claims accurately and within contractual turnaround times.

• Code medical procedures, diagnoses and supplies.

• Coordinate benefits with other group health plans.

• Interpret plan documents and apply plan benefits based on that interpretation.

• Verify eligibility and authorization.

• Assist Customer Service with benefit clarification.

• Refer appropriate claims, pre-certifications and appeals to management and/or medical review.

• Request necessary documentation from providers and/or insureds.

• Assist in the investigation of possible fraudulent claims.

• Investigate injury cases for potential third-party or workers’ compensation liability.

• Process appeals and grievances in coordination with the Claims Supervisor.

• Request claim recoupments/refunds from providers/members, as required.

• Weekly reporting of high dollar claims.

• Perform other duties and functions as assigned.

Position Requirements

• Excellent verbal and written communication skills, including active listening.

• Ability to manage multiple priorities and meet deadlines.

• Working knowledge of coding, billing and medical terminology.

• Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.

• Working knowledge of federal regulation specific to the administration of self-funded employer health and welfare plans, including ERISA, Department of Labor and Health and Human Services.

• Ability to work with minimal supervision.

• Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity.

• Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.

• Ability to collaborate with multiple parties to solve problems.

Competencies

• Accountability and Dependability: Assumes responsibility for accomplishing duties in an effective and timely manner.

• Integrity:  Consistently honors commitments and takes responsibility for actions and words.

• Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learn effectively with computer-based and/or online training.

• Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.

• Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Skills and Education

• Associates degree, or applicable professional experience, required

• Minimum 1 to 3 years experience in a healthcare or insurance industry setting.

Benefits              Competitive benefit package

Salary                   $25 per hour

Aspire Health Plan is an equal opportunity employer.

Assigned Work Hours:

M-F, 8am-5pm

Hybrid schedule. On-site one week a quarter, or as otherwise dictated by business needs.

Position Type: