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Why This Job Matters:
- Conduct complex analysis of claim payments to identify cost avoidance opportunities.
- Apply root cause analysis to develop solutions for payment integrity issues.
- Ensure compliance with state and federal guidelines.
What You Will Do:
- Conduct thorough analysis of medical claims.
- Create new reports to identify cost avoidance opportunities.
- Provide data and analysis to management on findings affecting payments.
What You Need to Succeed:
- Bachelor’s degree in a related field or equivalent experience.
- Seven or more years of experience in medical claims review.
- Seven or more years of experience in quantitative or statistical analysis.
Blue Cross & Blue Shield of Rhode Island
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.