Sr Analyst - Claims Specialist

Responsibilities

• Professionals in this group focus on processing insurance claims.
• They validate members, provider and other claims information.
• Professionals determine accurate payment criteria for clearing pending claims based on defined policy and procedure.
• They maintain productivity goals, quality standards and aging timeframes and scrutinize medical claim documents and settlements.
• They are involved in settlement of disputes and preparing case recovery through negotiations with the third party and providers.
• Professionals in this group work as fully contributed team member under broad supervision.
• They further build up on domain expertise along with technical skills.
• They work on complex projects which are not similar or routine based using standard concepts and principles using their knowledge and judgement.
• They require a professional degree along with many years of work experience and are responsible for coaching/mentoring junior team members.

Qualifications

• Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience.

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