Claims Business Analyst, Medicare Advantage - CommuniCare Corporate

CommuniCare Health Services is currently recruiting for the position of Claims Business Analyst for our Medicare Advantage plan! This is a fully remote position.

PURPOSE/BELIEF STATEMENT

The position of Business Analyst (Claims) reports directly to Director of Operations with strong collaborative relationships with Appeals, Provider Relations and Contracting, and external vendors to ensure adhesion to Medicare claim processing requirements and payment requirements.

WHAT WE OFFER

As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.

QUALIFICATIONS & EXPERIENCE REQUIREMENTS

• Bachelor’s degree in business, health care administration, or similar; or at least 2 years of experience working in health insurance field
• 2 years of experience with government health insurance (Medicare, Medicare Advantage, Medicaid) preferred
• Health insurance plan claim processing experience (adjudication, audit, review)
• Claim appeal experience preferred
• SQL familiarity and ability to run basic queries with interest in learning more
• Excellent time management skills including prioritization and preparedness
• Excellent communication skills, both verbal and written
• Exceptional attention to detail and ability to meet all required deadlines
• Ability to multi-task and adapt to changing priorities
• Proficient typing skills, ability to work in Office applications and program software programs

KNOWLEDGE/SKILLS/ABILITIES

• Expert level Excel experience
• Must have Medicare regulatory knowledge
• Must be flexible, able to work independently, and able to achieve deadlines and deliverables with minimal supervision.
• Must have ability to work effectively with people coming from diverse cultural and professional perspectives.

JOB DUTIES & RESPONSIBILITIES

• Effectively review and audit medical claims, identify inaccuracies in processing, perform root cause analysis, and provide input on solutions
• Monitor claims trends to ensure timely identification of configuration and payment errors
• Analyze report results, pinpoint trends and correlations in complicated data sets utilizing Excel and SQL
• Research and interpret Medicare claim processing regulations and requirements
• Research and respond to claim questions from various business areas (Appeals, Provider Relations, Providers)
• Develop automated and re-useable routines for extracting claims data
• Assist with CMS regulatory reporting 

Qualified candidates, apply now for a chance to join our outstanding team!

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