Intake Care Associate Analyst

Intake Care Associate Analyst: The preauthorization, claims review, negotiation and care coordination analyst is responsible for managing the full continuum of care management and cost containment activities-from pre-service authorization through post-service claims review and provider negotiations.

This role ensures clinical appropriateness, policy compliance, and cost-effective care delivery while coordinating services for complex and high-risk members to improve outcomes and member experience.

Key Responsibilities

Preauthorization/Utilization Management:

• Review and process preauthorization requests for medical services, procedures, and treatments
• Assess medical necessity using clinical guidelines, policy criteria, and regulatory requirements
• Collaborate with clinical teams to ensure appropriate level of care and service utilization
• Identify high-risk or high-cost cases early and route for care coordination or case management intervention
• Conduct detailed reviews of medical claims for accuracy, coding integrity, and benefit alignment
• Identify billing discrepancies, overutilization, and potential cost-saving opportunities
• Support appeals, reconsiderations, and audit activities as needed
• Analyze trends in high-cost claims and recommend process improvements
• Lead or support negotiations for out-of-network claims, high-cost procedures, and single case assignments
• Partner with provider network and contracting teams to align negotiation approaches
• Document and track savings outcomes, including financial and operational impact
• Partner with case management, clinical teams, and providers to ensure continuity and quality of care

Qualification/Skills

• Degree or Diploma; additional education in healthcare, business, or related fields preferred
• Knowledge of medical claims adjudication, prior authorization processes, medical necessity review, and utilization management guidelines, with the ability to review clinical documentation and apply established coverage criteria
• Coding certification (e.g., CPC, CCS) a plus but not preferred
• Excellent communication skills, both written and oral, with a good telephone manner
• Flexibility and ability to multi-task
• High level of accuracy and attention to detail
• Problem-solving and decision-making
• Team player
• Ability to interpret key data and identify trends
• This role operates on a 24/7 schedule. Selected candidates will be assigned to one of the following shifts: 8:00 PM - 6:00 AM EAT (Sat-Wed), 9:00 PM - 7:00 AM EAT (Wed-Sun), or 7:00 AM - 3:00 PM EAT (Sat-Wed). Flexibility to work weekends and holidays is required.