Senior Claims Business Analyst - Healthcare

- Handle property claims, limited in scope, based on claims guidelines.

- Research, create, and maintain all reimbursement related information and data to ensure regulatory compliance.

- Follow all policies and procedures established for the department.

- Answer client/patient questions to ensure understanding and client/patient satisfaction, or refers them to more senior level staff.

- Analyze and process claims in accordance with plan provisions.

- Develop and maintain strong business relationships with internal and external customers.

- Manage reserve adjustments and payments to avoid deficit payments.

- Maintain compliance with claim routing and inventory control procedures.

- Oversee advanced claim inquiries and assist claims staff with responding appropriately as needed.

- Calculate monthly contractual allowances, post journal entries, and explain variances to budget and prior periods.

- Document, track and resolve all plan providers' claims projects.

- Adhere to all statutory and regulatory fair claims practices.

- Assist in the maintenance of the guidelines for the processing of specialty accident and health insurance claims.