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CLAIMS ANALYST III

City:  Norwood
State:  OH
Job Requisition Number:  184079

Attention current TriHealth employees:

Please apply for this position by submitting an online internal application via SuccessFactors. Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.

CLAIMS ANALYST III: This position receives, priorities, and directs claims work flow to ensure processing turn-around-time obligations are met. This position oversees the training of new hires within team, identifies and problem solves issues in accordance with State and Federal guidelines, and is the primary representative for claims processing communications between the plan and claims team. Primarily responsible for adjustment projects, claims reports, Regulatory corrections, and auditing completed work of team members. This position safeguards patient confidentiality in all matters associated with all work involved and exhibits and promotes service excellence. The position requires a strong attention to detail.

MINIMUM REQUIREMENTS:

EDUCATION: High School Degree

EXPERIENCE: 3-4 years claims examiner role processing claims for fully covered commercial and Medicare populations in HMO or TPA environment

SPECIALIZED KNOWLEDGE: Experience in fast paced customer driven environment; multiple computer applications; excellent verbal/written skills; med terminology, CPT/ICD-9 coding, medical benefits interpretation, pre-existing conditions, exclusions, COB, third-party, capitation.

TRIHEALTH VIDEO

Job Title:  CLAIMS ANALYST III

Department Name:  TRIS NON HOSPITAL BILLING

Location:  Norwood

Hourly/Salaried:  Hourly

Employment Status: Full Time Position

Bi-Weekly Hours:80

Shift: Day Shift

Weekend Commitment:  No

Holiday Commitment:  No

On-Call Commitment:  No


Nearest Major Market: Cincinnati

Job Segment: Medical, Medicare, Healthcare