Wollborg Michelson is seeking Senior Claims Analysts for a renowned healthcare insurance company located in Woodland Hills, CA. We are currently interviewing as the client would like to meet candidates immediately! These positions are 6 months - 1 year contract opportunities with a possibility to be temp-to-hire with excellent performance and attendance.
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Senior Claims Analyst
Configuring into Core Reimbursement System
Position Purpose: The Senior Claims Analyst creates, updates, tests and maintains system configuration tables and files to support accurate claims adjudication in a multiple product, multiple state, managed care environment.
- Configure contracted provider contracts into claims system to determine appropriate amounts for adjudication.
- Maintain and update provider databases to include key provider demographics and specialty provider information
- Audit provider insurance policies to confirm compliance with contract requirements
- Load contracted rates into claims system
- Knowledge of CPT/ICD 9-10
- Must be detail oriented
- Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties.
- Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
- Review new and current provider contracts and established state guidelines
- Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff
- Troubleshoot and problem solve contract implementation issues related to basic system configuration
Education/Experience: Bachelor’s Degree or an equivalent combination of education and experience in a managed care environment. Minimum one to two years experience in an automated medical claims environment and managed care/multiple product environment desired. Minimum one to two years experience in systems logic and testing desired.
Role: Senior Claims Analyst
Location: Woodland Hills,
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