Claims Analyst

Multiple Immediate Openings - Hybrid Work!! All successful candidates must reside in the Bend, Oregon area.

Positions allow employees to work from home!

Current openings are full time, lasting 3+ months with the opportunity to apply for full time, permanent positions within the organization.

At Quantum Recruiters we focus intently on providing talent to leading employers throughout the Pacific Northwest. For over 80 years, our client has built a reputation based on taking great care of people by delivering insurance plans to individuals and business throughout the Northwest. We are currently recruiting to fill several contract administrative positions.

Job Profile Summary

Perform mail sort duties, fax queues, and prepare claims for scanning. Enter claims from imaging work queues. Process/prepare professional and facility medical and/or dental claims pended for manual adjudication in assigned Workflow roles. Perform follow-up with providers and members as necessary.

Job Description

Essential Responsibilities:

• Perform claims data entry tasks and accurately transfer data from claim images into Facets.
• Sort and batch incoming paper claims for scanning. Attach appropriate batch cover sheet to facilitate accurate return of claims images into the proper OnBase work queues.
• Work the fax queues on a daily basis.
• Review and accurately route medical/dental claims that pend for manual adjudication in assigned claims processing Workflow roles according to member’s plan benefits and department claims processing policies and procedures.
• Verify accuracy of data entry including patient information, procedure and diagnosis codes, amount(s) billed, and provider data.
• Review plan/group and determine routing of claims into the system.
• Use Notes system to record pertinent information involving a claim or member.
• Document issues that affect claims processing quality and advise team leader of claims processing concerns and/or problems.
• Work closely with other departments to ensure data accuracy.

Work Experience:

• One year office experience; health related experience preferred.

Education, Certificates, Licenses:

• High school diploma or equivalent.

Knowledge:

• Ability to develop a thorough understanding of products, plan designs, provider/network relationships and health insurance terminology.
• Research skills and ability to evaluate claims in order to enter and process accurately.
• Preferred computer skills include keyboarding and 10-key proficiency, basic Microsoft Word and Excel.
• Ability to prioritize work and perform under time constraints.
• Team player willing to collaborate and help others accomplish team objectives.

Competencies:

• Adaptability
• Building Customer Loyalty
• Building Strategic Work Relationships
• Building Trust
• Continuous Improvement
• Contributing to Team Success
• Planning and Organizing
• Work Standards

To be considered for this exciting opportunity, please submit your resume for immediate review.