Job ID Number

R4679

Employment Type

Full time

Worksite Flexibility

Remote

Job Summary

As a Claims Processor Analyst, you will receive, investigate, and triage expedited appeal requests, ensuring timely processing of health insurance claims and appeals in compliance with regulatory standards, while performing claims research, authorization lookups, and maintaining case assignments.

Job Description

We are looking for a Claims Processor Analyst , you will receive, investigate, and triage expedited appeal requests, ensuring timely processing of health insurance claims and appeals in compliance with regulatory standards, while performing claims research, authorization lookups, and maintaining case assignments. This is a full-time, remote, 6+ month contract position.

Due to the nature of this position, all candidates must be able to work direct for any employer without sponsorship.

Schedule:

• Monday to Friday

• 8-hour shift starting between 7am - 9am

What You’ll Do

• Receive, investigate, and triage expedited appeal requests from members/member representatives enrolled in Senior Products

• Timely assignment of cases to ensure member's appeal rights are processed in accordance with regulatory agencies' standards, including the Center for Medicare and Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA)

• Claims research and processing, focusing on understanding why claims were denied

• Processing appeals in the system

• Authorization lookups

• Processing health insurance claims

What You’ll Need

Required:

• At least 1 year of experience in health insurance claims and appeals is required

• Outbound call experience is a plus (though not a major part of the job)

• Customer service background and experience

• High School Degree

Desired:

• A college degree and/or extensive experience would be considered

• Medicaid experience is highly desired

Physical Demands:

• Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state and local standards

• Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc.

• Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor

#LI-KM1

Reasonable Accommodation Statement

If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 – 8111.

Equal Employment Opportunity Policy Statement

It is the policy of CAI not to discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Employees and applicants of CAI will not be subject to harassment due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.