Claims Analyst

The Claims Analyst ensures member and provider satisfaction by providing appropriate and timely adjudication of complex claims. These are the most complex and unique claims, which require the incumbent to work independently while using appropriate judgment to achieve correct resolution. The incumbent must also demonstrate strong problem solving and analytical ability.

EDUCATION: (Minimum educations & certifications required)
Associates degree or equivalent business experience in claims/customer service healthcare environment preferred.

EXPERIENCE: (Years of experience)
Minimum of 18-24 months experience in Tufts Health Plan Claims and/or Customer Service position preferred. Requires a thorough understanding of CPT, ICD-9 and HCPCS coding guidelines.

SKILL REQUIREMENTS: (Include interpersonal skills)
Ability to demonstrate understanding and proficiency of the most complex claim concepts strongly preferred. Requires excellent problem solving and analytical skills. Must have a thorough knowledge of either Tufts HP POS or HMO product, claims concepts and adjustment guidelines. Also, must be proficient in MS Windows and Tufts Health Plans systems. Must be a problem solver with initiative and possess an ability to prioritize tasks and follow through to completion.

Must be able to work independently and cooperatively as a team member. Must be able to effectively communicate with internal and external customers in verbal and written format.

If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1371597-1867-1749