Senior Healthcare Claims Analyst

If you’re looking to join a firm that is as committed to you as we are to our clients, keep reading!  At PBMares you’ll find great people, challenging work, rewarding opportunities and a culture that embraces integrity, creativity, and teamwork.  We’re a perennial top-100 firm according to Inside Public Accounting and Accounting Today recently named us one of the fastest growing firms overall.  Continuous learning, work-life balance, and challenging opportunities are just a start.  We’re over 300 strong in 10 offices across Virginia and Maryland and we are looking for new teammates.  Check out our openings and talk with us!

Become part of a high caliber team to assist in assessing the accuracy of healthcare and other benefit payments issued by national insurance carriers. As a Senior Healthcare Claims Analyst you will be responsible for performing comprehensive research to identify provider billing abnormalities and claim payment errors with the overall goal to ensure proper benefit administration for our clients.  This role will be based out of our Baltimore office located along the Inner Harbor.

Core Responsibilities

• Performs assigned audits in a professional manner and in accordance with the approved audit program
• Evaluates the adequacy of internal controls and compliance with company policies and procedures by examining transactions, documents, records and reports, and observing procedures
• Identifies and defines issues and reviews and analyzes evidence
• Prepares working papers, which record and summarize data on the assigned audit segment, in accordance with professional standards
• Assists in recommendations and writing reports documenting the results of the audit
• Utilizes data for the purpose of verifying errors and identifying systemic errors
• Works as an active team member during scheduled engagements and work collaboratively to achieve the goals of the team
• Provides feedback to the team lead on any issues identified during research or claims review.

Job Requirements

• Bachelor’s Degree required
• Minimum 3-5 years of experience with healthcare claims, billing, and/or coding directly for a hospital system, consulting firm, or major insurance company
• A strong working knowledge and understanding of the healthcare industry
• Strong communication skills, including the ability to build relationships and articulate thoughts clearly and effectively
• Willing to travel 15 – 20 weeks per year

Our Firm’s policy is to provide equal opportunity for employment  to all individuals regardless of their race, color, religion, sex, national origin, age, genetic information, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by federal, state, or local laws. 

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

This contractor and subcontractor shall abide by the requirements of 41 CFR 60-741.5(a).  This regulation prohibits discrimination against qualified individuals on the basis of disability, and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with disabilities.

Must be authorized to work in the United States permanently without the requirements of sponsorship at any point in the future.