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We are seeking a motivated individual to join our team as a Medical Claims Quality Analyst. Positions in this function are responsible for providing expertise in claims / EOB knowledge.
Individuals in this position will review and analyze data, present information related to facility claim information in an attempt to identify trends, competitor reimbursement and contract practices. Individuals will also contribute to development and implementation processes and business solutions through research and analysis of data.
- Use pertinent data and facts to identify and solve a range of problems within area of experience
- Understand and interpret explanations of benefits (EOB) data from variety of carriers in a variety of formats
- Basic analysis and investigation of trends in the data and competitors product and rates
- Retrieve and interpret claim reports to assist with efficient and accurate documentation of claims for delivery to internal and external customers
- Research, identify and obtain data / information needed to help accurately interpret the data as needed
- Provide feedback to co-workers through peer review process
- Anticipate customer needs and contribute to proactive identification of solutions
- Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer