Summary
Location
Corpus Christi
Type
full-time
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About this role
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose:
The Claims Processing Analyst performs claims analysis and associated responsibilities in support of the claims administration and performs other related work as required.
Claims Analyst II: In this position, individuals perform a full range of tasks under supervision, while exercising discretion and independent judgment and established procedures. Examples of responsibilities include:
- Claim review / analysis of moderate to advanced complexity
- Complex provider contract pricing
- High dollars claim review
- Claim research
- Claim issue resolution
Essential Duties and Responsibilities:
- Validate submitted claims data to ensure accuracy, validity, and integrity.
- Analyze pending claims and collaborate with internal business partners for necessary information and assistance, according to departmental procedures.
- Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality.
- Evaluate claims issues and procedures to identify and suggest opportunities for improvement, both in efficiency and quality.
- Openly participate in team meetings, providing ideas and suggestions to ensure departmental best practices, and to develop and promote teamwork.
- Maintain required compliance with privacy and confidential standards.
- Maintain or exceed all established standards for performance, quality, and timeliness.
- Support the Claims department in review, investigation, and research of claims issues and completion of claims projects.
- Communicate effectively, in verbal or written form, by sharing ideas and reporting facts and issues.
- Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.
- Assist with other related work responsibilities as requested
Education and Experience:
- Minimum of five years’ professional experience in claims analysis, provider medical billing, or medical coding.
- Proficiency with Microsoft Excel and Word, as well as with medical terminology coding and billing concepts.
- Advanced experience with health insurance and managed care principles.
- Experience with Complex claims analysis and resolution.
- Ability to work independently, or in a team environment, toward meeting common goals. Integrity and discretion to maintain confidentiality of member and provider data.
Other facts
About DRISCOLL HEALTH PLAN
DRISCOLL CHILDRENS HEALTH PLAN is a hospital & health care company based out of 615 N Upper Broadway St, Corpus Christi, TX, United States.
DHP is a non-profit, community based health insurance plan in south Texas which is part of the Driscoll Children's Health System. DHP products include STAR Medicaid, STAR Kids, CHIP, and CHIP Perinatal plans and covers 24 counties with over 6,000 providers and 230,000 members within the Driscoll network.
What you'll do
- The Claims Processing Analyst II performs claims analysis and supports claims administration. Responsibilities include validating claims data, analyzing pending claims, and collaborating with internal partners.
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