Systems Analyst (healthcare insurance claims )

Client is looking for System Analyst with encounter processing background (heavy claims processing experience)

Job Description:

Responsible for keying processing and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO PPO COB etc.). Primary duties may include but are not limited to: Able to handle more complex claim with a good understanding of the application of benefit contracts pricing processing policies procedures government regs coordination of benefits& healthcare terminology. Good working knowledge of claims and products including the grievance and/or re-consideration process. Excellent knowledge of the various operations of the organization products and services. Reviews analyzes and processes claims/policies related to events to determine extent of companys liability and entitlement. Researches and analyzes claims issues. Responds to inquiries may involve customer/client contact. Requires a HS diploma or equivalent and a minimum of 1 year of claims processing experience; previous experience using PC database system and related software (word processing spreadsheets etc.); or any combination of education and experience which would provide an equivalent background.

Required Skills : Systems Analysis

Basic Qualification :

Additional Skills : Systems Administrator

This is a high PRIORITY requisition. This is a PROACTIVE requisition

Background Check : No

Drug Screen : No