[Hiring] Claims Analyst @Captrue Benefits LLC

Role Description

The Claims Analyst is responsible for the review and analysis of medical and dental claims for accuracy and completeness, and the adjudication of claims based upon specific knowledge and application of each client’s unique self-funded plan(s). This will include claims research where applicable and a range of claim complexity.

Salary Range: $52,000 - $62,000

A sample of what you’ll get to do in this job:

• Review, analyze, and adjudicate medical and dental claims in a timely and accurate fashion in accordance with company policies, regulatory requirements and client plan document provisions.
• Validate claim information to ensure completeness and accuracy; address any discrepancies or missing data.
• Pay, pend, or deny claims based on eligibility, precertification, COB, medical review, and claims policy.
• Facilitate claims audit and investigation activities with third-party reviewers.
• Resolve claims appeals, adjust claim payments, handle overpayments/refunds and verify correct plan loading.
• Consistently meet departmental standards for quality, productivity, and attendance.
• Deliver exceptional service to internal and external parties, addressing plan coverage and payment inquiries.
• Adhere to and apply all applicable privacy and security laws, including HIPAA, HITECH and any regulations promulgated thereto and maintain a secure work area.
• Attend training sessions to enhance knowledge of the claim system and industry standard practices.
• Perform various other tasks assigned.

Qualifications

• Minimum 4+ years of medical claim adjudication or related experience.
• In-depth knowledge of health plans/benefits, TPA/self-funding processes, medical terminology and professional/institutional claims adjudication.
• Excellent customer service skills with a strong sense of ownership and commitment to completing tasks with follow-through.
• Detail oriented with demonstrated ability to work independently, problem-solve and make decisions.
• Demonstrated ability to work in a dynamic and fast-paced environment managing multiple priorities with pressure of production schedules and deadlines.
• Knowledge of HIPAA regulations and a commitment to maintaining compliance with privacy and security standards.
• Proficiency in Microsoft Office (Word, Excel, Outlook) and data analysis.
• Prior experience working with a Third-party Administrator and/or VBA Software is highly preferred.
• High school diploma with equivalent work experience required.

Company Description

Captrue Benefits is a third-party administrator located in Minneapolis, Minnesota. Captrue Benefit’s mission is to change the way healthcare is financed, disclosed and delivered. We need people who value honesty and transparency; people who take ownership and responsibility of whatever they are doing. We seek individuals who value all people and interact with humility and respect; people who like to dig deep into issues, who are curious and who understand life is about more than work. If you believe in our mission and share our Core Values, then we would like to talk about how we can make a positive impact together.