Claims Analyst
A CAREER AT CAPTRUE BENEFITS
Working at Captrue Benefits, you’ll experience a culture that is made up of a group of people who are supportive, innovative, collaborative, and caring towards each other and the customers we serve. Captrue Benefits is looking for a Claims Analyst to join our team. This is a full-time position located in our Blaine, MN office, or remote, depending on location. Join our team and help us change the way healthcare is financed, disclosed and delivered.
OUR VISION FOR THIS KEY ROLE
The Claims Analyst is responsible for the review and analysis of medical and dental claims for accuracy and completeness, and the adjudication of claims based upon specific knowledge and application of each client’s unique self-funded plan(s). This will include claims research where applicable and a range of claim complexity.
Salary Range: $52,000 - $62,000
A SAMPLE OF WHAT YOU’LL GET TO DO IN THIS JOB
- Review, analyze, and adjudicate medical and dental claims in a timely and accurate fashion in accordance with company policies, regulatory requirements and client plan document provisions.
- Validate claim information to ensure completeness and accuracy; address any discrepancies or missing data.
- Pay, pend, or deny claims based on eligibility, precertification, COB, medical review, and claims policy.
- Facilitate claims audit and investigation activities with third-party reviewers.
- Resolve claims appeals, adjust claim payments, handle overpayments/refunds and verify correct plan loading.
- Consistently meet departmental standards for quality, productivity, and attendance.
- Deliver exceptional service to internal and external parties, addressing plan coverage and payment inquiries.
- Adhere to and apply all applicable privacy and security laws, including HIPAA, HITECH and any regulations promulgated thereto and maintain a secure work area.
- Attend training sessions to enhance knowledge of the claim system and industry standard practices.
- Perform various other tasks assigned.