Systems Analyst (healthcare insurance / claims )

System / Claims AnalystResponsible 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.