Medical/Pharmacy Claims Analyst - Remote | WFH

At Confidential, we're dedicated to revolutionizing the healthcare industry with our commitment to accuracy and reliability. As a part of our dynamic Operations team, you'll play a pivotal role in ensuring that every patient's journey is seamless and error-free.

Role Overview

As a Medical/Pharmacy Claims Analyst, you'll be at the forefront of our mission, meticulously monitoring and analyzing medical claims processed through our clearinghouse. Your keen eye for detail and expertise in healthcare claims transactions will be essential as you ensure the accuracy of every claim, contributing to our unwavering dedication to never letting the process fail the patient.

Key Responsibilities

Review and reconcile medical claims submitted daily through the clearinghouse to ensure successful receipt by payers.

Scrutinize claims for payment accuracy, adhering to processing rules and standards.

Identify and address denied or inaccurately paid claims, collaborating with teams to swiftly resolve issues.

Provide responsive support to Pharmacy Support and Client Services, addressing claim-related inquiries and proactively flagging necessary actions for accurate processing.

Communicate effectively to promptly resolve any issues, ensuring the seamless operation of daily claims activity.

Demonstrate Flexibility By Undertaking Additional Tasks As Required.

Uphold the highest standards of confidentiality and security in handling sensitive healthcare information, in accordance with HIPAA regulations.

Qualifications

2+ years of experience in healthcare claims and related transactions.

Preferred Knowledge Of Medical And/or Pharmacy Billing And/or Coding.

Familiarity with X12 and NCPDP transaction formats is advantageous.

SQL knowledge is desirable but not mandatory.

Strong communication, problem-solving, and detail-oriented skills are essential for efficiently managing significant claim volumes while multitasking to address ongoing challenges.

Benefits & Perks

Comprehensive healthcare coverage, including medical, dental, and vision.

Paid holidays and unlimited paid time off.

401(k) savings plan with company match.

Remote work and in-office flexibility to support your work-life balance.

Join us in our mission to redefine healthcare, where your expertise and passion for accuracy will make a tangible difference in patients' lives.

Employment Type: Full-Time