Claims Analyst

Position Overview

We are seeking a skilled Claims Analyst to join our healthcare team remotely, focused on managing commercial claims processing. The role includes working with MS Excel for data management during day shifts from home, ensuring precision and efficiency in claim handling that supports exceptional customer service and operational excellence.

Primary Duties

• Review and validate healthcare claims submitted by providers in line with US insurance policies.
• Operate on the QNXT claims platform, a mandatory requirement.
• Verify patient eligibility, coverage, benefits, and pre-authorization under Medicare, Medicaid, and commercial plans.
• Adjudicate claims by approving, denying, or adjusting according to payer rules and policies.
• Adhere strictly to HIPAA, CMS, and other relevant US healthcare regulations.
• Maintain comprehensive documentation of claims processes, create audit trails, and compile management reports.

Required Qualifications

• High school diploma or equivalent is mandatory.
• Strong understanding of US healthcare insurance frameworks including Medicare, Medicaid, and commercial insurance providers.
• Between 2 and 4 years of professional experience handling US healthcare claims.
• Familiarity with claims management software and handling Electronic Data Interchange (EDI) transactions.
• Possess excellent analytical, organizational, and communication skills.
• Ability to accurately interpret insurance policies and payer guidelines.
• Detail-focused with robust problem-solving skills.

Key Competencies

• In-depth regulatory knowledge of US healthcare legislation and payer mandates.
• Strong attention to detail and commitment to accuracy in claims processing.
• Effective problem resolution strategies for claim disputes and denials.