We’re looking for…

A Claims Analyst That will provide timely and accurate processing and adjudication of claims.  The role will research, and process claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare options.

What’s the role?

You will be responsible for:

• Review assigned claims or requests from a queue, maintaining a set inventory level.
• Analyze claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract, and/or policy.
• Perform claim rework, medical reviews, or other assigned projects as needed.
• Identify and report inaccuracies in adjudication related to system configuration, benefit inconsistencies, and fee schedules.
• Efficiently and accurately analyse medical claims to determine approval or denial for payment based on plan or client conditions.
• Resolve pending healthcare claims and prior approval requests.
• Assist other departments by contributing to projects, providing feedback, conducting research, and resolving inquiries related to claims adjudication.
• Achieve and exceed key performance indicators for performance, production, and quality.
• Contribute to personal, team, and organisational development through active participation in knowledge transfer, engagement, and initiatives.