Claims Analyst/ Claim QA Analyst

Pyramid Consulting
US - Florida - Tampa
January 17, 2025

Immediate need for a talented Claims Analyst/ Claim QA Analyst. This is a 06+ Months Contract opportunity with long-term potential and is located in Tampa, FL (Hybrid). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-55638

Pay Range: $19 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
Data Entry - Enter claim details and maintain accurate records within the claims management system.
Problem resolution - Investigate discrepancies and resolve disputes related claim processing.
Claims Appeals Experience - Should be able to perform the rework adjustment basis the provider appeals and internal rework/adjustment requirement.
Continuous improvement - Identify process improvement opportunities to enhance claims accuracy and efficiency.

Key Requirements and Technology Experience:

Skills-Claims Adjustment , Auditing , Quality Assurance.
Audits cases processed by processors.
Provide feedback to processors on errors committed.
Handle Client escalations when required.
Provide training to the team basis error trending.
Ensure Performance targets are met.
Identify knowledge gaps/ issues in the team.
Initiate and coordinate calibrations with the clients or trainings within the team.
Share updates with the team.
Provide Analysis of Defects from core processing Standpoint and provide constructive feedback on the same.
Consistently add value to the existing process.
4 - 5 years of Experience within the Insurance / Healthcare field with exceptional knowledge of Claims processing.
2-4 year College Degree in Healthcare preferred/ High School diploma/GED Required. (all education certificates will be verified) .
Excellent Communication Skills (Verbal & Written)
Should be good with basics of Computer.
Strong customer service business, operational and procedural knowledge.
Ability to analyze and solve problems. Strong interpersonal, written and oral communication skills.

Our client is a leading IT Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Read the full job description and apply online on the recuiter's web-site

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