The Claims Production Analyst will manage thorough Review of health insurance claims and member eligibility to locate overpaid claims that are non-compliant or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.

Researches claims for accuracy and executes changes.
• Performs data validation.
• Audits incoming and outgoing claim files.
• Assists in loading claims to claims system.
• Assists in research for provider inquiries.
• Interacts with IT Department to facilitate workflow.
• Other duties as assigned.

Education:

• High School Degree or GED required.

Experience:

• 2- 5 years' experience working on claims processing systems.
• Experience in claims auditing a plus.
• Ideal candidate will have experience in medical claims for commercial, Medicare, and/or Medicaid.
• Thorough understanding of medical terminology.
• Proficient in Microsoft Office and especially Excel.
• Must be able to multi-task in a fast paced environment.
• Must possess excellent analytical skills.
• Knowledge of Internet applications and customer service tracking systems a plus.
• Detail oriented team player.
• Excellent verbal and written communication skills.

Base compensation $21.50 an hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(K) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 04/18/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 6/18/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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