Claims Analyst II

Position Purpose: Ensure timely processing of complex pending medical claims.

Verify and update information on the submitted claims.

Review work processes to determine reimbursement eligibility.

Ensure payments and/or denials are made in accordance with company practices and procedures.

Process first time claims with added complexity.

Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.

Research and de…