BusinessOperations - Claims Analyst 1 - 120060

Position Purpose:
Ensure timely processing of pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company protocols and procedures. Ability to successfully complete additional progressive claims training programs within 12 months of hire.

Education/Experience:
High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician s office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). Ability to perform basic math functions. Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.

For Centene Dental & Vision Services: Claims refers to dental and/or vision claims. Experience in processing Dental or Vision claims preferred. Working knowledge of ICD-9/10, CDT and dental terminology preferred. Experience with Medicaid or Medicare claims preferred.


Process first time claims

Apply policy and provider contract provisions to determine if claim is payable

Research and determine status of medical related claims

Maintain records, files, and documentation as appropriate

Meet and maintain department production and quality standards

Successfully complete additional progressive claims training programs as required


Performs other duties as assigned

Complies with all policies and standards

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Position Purpose: Ensure timely processing of pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company protocols and procedures. Ability to successfully complete additional progressive claims training programs within 12 months of hire. Education/Experience: High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician s office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). Ability to perform basic math functions. Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred. For Centene Dental & Vision Services: Claims refers to dental and/or vision claims. Experience in processing Dental or Vision claims preferred. Working knowledge of ICD-9/10, CDT and dental terminology preferred. Experience with Medicaid or Medicare claims preferred. Process first time claims Apply policy and provider contract provisions to determine if claim is payable Research and determine status of medical related claims Maintain records, files, and documentation as appropriate Meet and maintain department production and quality standards Successfully complete additional progressive claims training programs as required Performs other duties as assigned Complies with all policies and standards
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		The Vision Claims Processing team is responsible for the timely and accurate processing of vision claims to ensure members and providers receive prompt claim adjudication while meeting organizational production and quality standards. This is a backfill for a team member who accepted the VSP separation package. We are a fully remote team of approximately 11 associates. Team members are assigned individual work queues and processes to complete daily. We collaborate to ensure claims are processed accurately and efficiently while maintaining productivity and quality expectations. An additional backfill is anticipated in December due to another employee accepting the VSP opportunity. Not needed at the moment
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			Associates log in and work assigned claim processing queues throughout the day. Responsibilities include reviewing, processing, pricing, and, when appropriate, denying vision claims according to established policies and procedures. Performance is measured through weekly production and quality metrics, with expectations of maintaining at least 75% production and 96% quality. This role is unique because it directly impacts the timely delivery of vision benefits by ensuring claims are processed accurately and efficiently. Associates work independently while contributing to a collaborative, high-performing remote team that is driven by production and quality metrics.
Candidate Requirements
Education/Certification	Required: High school diploma or equivalent.				Preferred:
Licensure	Required: n/a				Preferred:
Years of experience required: 1 year of any claims processing experience but healthcare is preferred Disqualifiers: * Inability to meet production and quality expectations. * Limited computer proficiency or difficulty working in multiple systems. * Poor attendance, reliability, or ability to work independently in a remote environment. Additional qualities to look for: * Strong attention to detail and accuracy. * Excellent time management and organizational skills. * Ability to adapt to changing priorities and learn new processes quickly. * Strong written and verbal communication skills. * Self-motivated with the ability to work independently while contributing to a team.
Top 3 must-have hard skills stack-ranked by importance			1	Claims Processing Experience Experience reviewing, processing, and adjudicating health or vision claims.
			2	Computer & Systems Proficiency Ability to navigate multiple applications simultaneously while maintaining efficiency and accuracy.
			3	Production & Quality Performance Proven ability to consistently meet productivity goals while maintaining high-quality standards.
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting
			Type of Interviews:			Remote/Phone
			Required Testing or Assessment (by Vendor):			N/A
Next Steps
Do you have any upcoming PTO?			NO
Colleagues to cc/delegate			Valerie Lawrence