Claims Investigation Analyst

Virtual Vocations Inc · Workfromhome, United States

Working remotely in a full-time capacity, the Claims Investigation Analyst will review and resolve complex claims issues while acting as a liaison between providers and Health Plan departments, ensuring accurate communication and adherence to established guidelines. Key responsibilities: Evaluate and resolve complex claim and provider billing issues in a timely manner Educate providers on claims submission requirements and facilitate issue resolution Document inquiries and complaints accurately while identifying trends to improve processes Required qualifications: High School Diploma or Equivalent (GED) required Minimum of 4 years of relevant experience required Experience with state and federal guidelines related to claims processing Ability to provide professional guidance and support to providers Familiarity with claims audits and payment terms configuration