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Corporate Functions & Operations WellCare - Claims Careers

Claims Analyst Job

Full Job Title: Claims Analyst

Job Number: 1700671

Location: Phoenix, AZ

Date Posted: 3-31-2017

This position is forCare1st Health Plan, a WellCare Healthplans, Inc. company.

We are Care1st Health Plan Arizona and we are growing! Care1st is an AHCCCS and KidsCare health plan available in Maricopa and Pima Counties. Our mission is to be the most provider-oriented managed care organization that will strive to continuously improve the quality of services available to its members. We were proud to be ranked highest in the provider survey among all other AHCCCS contracted health plans. Come join our winning team! Our Claims team has been described has dedicated, goal oriented and committed to maintaining a high standard of excellence within the industry. They also have fun! Due to our growth, we have multiple Claims Analyst opportunities available. We are looking for qualified candidates to work in our Phoenix office and well as candidates who are looking for a telecommuting position.Please note that the opportunity to telecommute will be determined 90 days in the position.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Accurately adjudicate claims in accordance with health plan guidelines, company standards, and company procedures
  • Maintain minimum production standards as set by Care1st Maintain a 98% or above financial accuracy rate and a 95% or above procedural accuracy rate
  • Review claims for appropriate information and accurate reimbursement
  • Prioritize and manage individual workflow as needed
  • Maintain completed and updated set of resource materials necessary for processing claims
  • Attend all company-mandated training and remain current with knowledge in the claims field
  • Assist with data entry of claims as needed
  • Other duties as assigned

QUALIFICATIONS:

  • High school diploma or GED
  • 3-4 years of claims processing (Commercial experience preferred)
  • Knowledge of CPT, HCPC, ICD-9, and Revenue codes, medical terminology, general billing guidelines, pricing, and provider contracts
  • Experience in processing claims according to multiple plan guidelines
  • Experience with application of deductible, coinsurance, and copayments
  • Ability to research and adjudicate CMS-1500 and UB-04 claims of all levels of complexity
  • Analytical skills to resolve complex claims
  • Strong multi-tasking skills and the ability to identify and trend processing/billing issues
  • Must be organized with a positive attitude
  • Working knowledge of Microsoft Word, Excel, and Outlook
  • Ability to work as a team player in a professional, fast-paced environment
  • Able to communicate effectively and tactfully in both oral and written form

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Last Updated On: 12/9/2015