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Lead Claims Analyst

Company: Health Net, Inc.
Location: Great Falls
Posted on: October 11, 2019

Job Description:

Description: Position Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues * Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims * Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis * Assist in creating work flows for the department and support team members in understanding changes in work processes * Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues. * Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions. * Maintains records and reports as assigned * Assist in meeting departmental production and quality standards * May process claims when needed

Keywords: Health Net, Inc., Great Falls , Lead Claims Analyst, Professions , Great Falls, Montana

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