Remote Claims Analyst

As a Claims Analysts you will play a key role in Guidehealth’s expansion and growth. You will be responsible for the adjudication of claims that require high level review and investigation according to plan requirements and maintain an average daily quantity and quality production requirement. This position will report to the Manager, Claims. You will be responsible for adjudication of medical healthcare claims that PEND during the auto adjudication process for high level review and maintain daily production requirements meeting the federal prompt pay turnaround times, meet or exceed a quality score of greater than 95% and the minimum required per hour claim production. Complete the weekly pre-adjudication audit reports for payment accuracy prior to weekly check cycles. Attend weekly 1:1’s with manager for continued feedback conversations and monthly team meetings. Communicate system issues to the manager for further investigation and JIRA ticket entry. Other duties as assigned.