Senior Claim Benefit Specialist (Encounter Corrections Analyst)

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Senior Claim Benefit Specialist (Encounter Corrections Analyst) researches, reviews, and adjudicates complex, sensitive, and specialized encounters in accordance with state-specific processing guidelines.

Responsibilities

• Adjudicate complex, sensitive, and specialized claims with accuracy in the claims processing system.
• Consistently meet quality and production expectations.
• Identify and escalate issues that impact claim payment accuracy or create rework.
• Partner cross-functionally to resolve barriers to encounter acceptance.
• Contribute to the development of desktops and standardized procedures.
• Balance competing priorities while supporting multiple markets.
• Engage in working sessions and meetings that advance business objectives and Key Performance Indicators (KPI).

Required Qualifications

• Minimum 2 years of medical claims processing experience (Commercial, Medicaid, Medicare).
• Experience working in a production environment.
• Strong analytical and problem-solving skills, especially in researching claims.
• Proficiency in MS Office Suite applications; Excel, Word, OneNote.
• Ability to work independently and as a team.

Preferred Qualifications

• QNXT or Facets claims processing experience.
• Experience in Medicaid or Medicare claims.
• Encounters experience.
• Edifecs system knowledge.

Education High School Diploma

Anticipated Weekly Hours 40

Time Type Full time

Pay Range $18.50 - $35.29

Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.