Remote Claims Analyst - SQL Experience Required

• Review, investigate, and adjudicate healthcare claims accurately and efficiently
• Evaluate claims to ensure payments are appropriate for services rendered
• Review suspended claims and verify HCPCS codes, units, service dates, and authorizations
• Analyze member information to identify coordination of benefits (COB) opportunities and coordinate with other carriers when applicable
• Resolve claims processing issues involving Medical Management, Enrollment, Customer Service, Network Development, and other departments
• Monitor claims workflows and recommend process improvements to increase efficiency and accuracy
• Respond to inquiries from providers, members, and internal stakeholders
• Oversee claims appeals processing and provide guidance on appeals procedures
• Conduct audits and quality reviews to ensure compliance and accuracy
• Participate in special projects, reporting initiatives, and regulatory audit activities
• Assist with training and education for internal and external staff as needed

Do you have experience in SQL?, * Minimum of 2 years of claims processing, claims analysis, or healthcare claims experience required

• Experience reviewing and adjudicating medical claims preferred
• Strong understanding of healthcare claims regulations, billing practices, and reimbursement methodologies
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Ability to work independently in a remote environment
• Proficiency with Microsoft Office and claims management systems
• SQL experience required
• Knowledge of Medicare and Medicaid guidelines required

$20 an hour - Full-time, Contract, Pulled from the full job description

• Referral program
• 401(k)
• Health insurance
• Paid time off, * Fully remote opportunity
• Monday-Friday schedule with no weekends required
• Competitive hourly compensation
• Opportunity for contract extension
• Immediate start available, * 401(k)
• Health insurance
• Paid time off
• Referral program