The Claims Analyst is responsible for reviewing, analyzing and processing medical and/or dental claims. This role is responsible for analyzing claims from first submission and processing them to the final payment while maintaining complete accuracy, production and quality standards.
Responsibilities
Analyzing/Processing
- Gain and maintain the understanding of the plan designs and effectively apply that knowledge.
- Analyze claims as appropriate from first submission to finalizing.
- Maintain complete and accurate processing.
Teamwork
- Work cooperatively with other team members
- Actively participate in team meetings and training activities.
- Perform additional responsibilities and projects as periodically assigned.
Education/Certification:
- (Minimum) High School Diploma/GED
- Three (3) years recent experience processing medical claims
Skills/Abilities:
- Ability to maintain production and quality standards.
- Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.
- Ability to read, analyze and assess medical documentation and draw valid conclusions.
- Minimum 40 WPM and 3,000 KPH proficiency
- Solid knowledge of MS Excel & MS Word (i.e. pivot tables and lookup functions).
- Professional, client-focused approach to colleagues and assignments.
- Strong oral and written communication skills with exceptional attention to details.
- Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
- Strong dedication to follow-through on all tasks and assignments.
- Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.
- Ability to sit for long periods of time operating a computer keyboard.
Employee Benefits Program
COMPANY PROVIDES:
- MEDICAL, DENTAL, VISION
- SHORT-TERM DISABILITY
- Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.
- COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
- COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
- 401K Plan including company match up to 5%.
- COMPANY PAID additional pension plan entirely funded by the company.
- EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
- Annual, automatic pay increases.
Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.
Skills Required
- High school diploma or GED
- Three years of recent experience processing medical claims
- Knowledge of medical terminology, CPT codes, ICD-9/10, and medical claim forms
- Ability to maintain production and quality standards
- Ability to read, analyze, and assess medical documentation and draw valid conclusions
- Minimum typing proficiency of 40 words per minute and 3,000 keystrokes per hour
- Knowledge of Microsoft Excel, including pivot tables and lookup functions
- Knowledge of Microsoft Word
- Strong oral and written communication skills
- Exceptional attention to detail
- Ability to organize, prioritize, work independently, and meet deadlines
- Ability to sit for long periods while operating a computer keyboard
What We Do
Southwest Service Administrators was created in 1995 as an independent Third Party Administrator (“TPA”) to provide unique and specialized services to labor-management, Taft-Hartley Trust Funds. Our mission is to provide superior customer service to our clients in all areas of self-funded health & welfare trust funds, defined benefit and defined contribution pension plans and legal, training and vacation plan administration. Our services are customized to suit the individual needs of our clients. Our services include highly personalized and bilingual customer service, trust fund accounting, eligibility and hour bank programs, COBRA/HIPAA compliance and administration and medical management services customized to each client’s needs and requirements. We also offer our own exclusive Mexico PPO network. We are versatile in our approach to solving client plan issues including innovative thinking as a means to simple, but effective, solutions. We welcome you to our homepage and encourage you to take a look around our website and call us if you have any questions about our company or service.
