Systems Analyst (healthcare insurance / claims )

Client is looking for System / Claims Analyst with encounter processing background (heavy claims processing experience)

Job Description :

Responsible for keying, processing and / or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w / basic understanding of multiple products (HMO, PPO, COB, etc.). Primary duties may include, but are not limited to : Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits,& healthcare terminology. Good working knowledge of claims and products, including the grievance and / or re-consideration process. Excellent knowledge of the various operations of the organization, products, and services. Reviews, analyzes and processes claims / policies related to events to determine extent of company's liability and entitlement. Researches and analyzes claims issues. Responds to inquiries, may involve customer / client contact. Requires a HS diploma or equivalent and a minimum of 1 year of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience which would provide an equivalent background.

Must have experience with outbound claims or encounters experience and SDLC experience this person would assist with wrap up testing and projects, not process claims or encounters - Candidate must have SDLC experience specific to 837 Encounter transactions / EDI transactions

Required Skills : Systems Analysis

Additional Skills : Systems Administrator