About this role
Claims Resolution Analyst to research and resolve claim inquiries for clients and brokers, ensuring accurate adjustments and timely communication while maintaining HIPAA-compliant remote operations.
Key Responsibilities
- Research and resolve all claim inquiries
- Analyze and adjust claims as appropriate
- Communicate findings to clients and brokers
- Track claim-related issues for trends
- Provide cross-functional support as needed
Technical Overview
Healthcare claims knowledge with experience in claims systems (Javelina, Facets); data tracking and reporting; strong Excel/Outlook skills
Ideal Candidate
The ideal candidate is an entry-to-mid level claims analyst with 1-3 years of healthcare claims experience and strong communication and organizational skills to support remote HIPAA-compliant processing.
Must-Have Skills
High school diploma or equivalent1-3 years of experience in claims processingclaims analysisor healthcare/TPA environmentFamiliarity with claims systems (e.g.JavelinaFacets)Basic understanding of medical claimsincluding pre-certification and prior authorization processesExperience researching and resolving claim issuesStrong written and verbal communicationAbility to manage multiple priorities and meet deadlinesProficiency in Microsoft Officeparticularly Excel and OutlookStrong attention to detailAbility to work independently while collaborating with internal teams
Tools & Platforms
JavelinaFacets
Required Skills
Claims processingclaims analysishealthcare environment familiarityclaims systems (JavelinaFacets)pre-certificationprior authorizationExcelOutlookHIPAA
Hard Skills
Claims processingClaims analysisFamiliarity with claims systemsJavelinaFacetsDocumentationExcelOutlook
Soft Skills
Strong written and verbal communicationAttention to detailProblem-solvingAbility to work independently and collaboratively
Keywords for Your Resume
claims resolution analystclaims processinghealthcareTPAJavelinaFacetspre-certificationprior authorizationclaims systemsExcelOutlookHIPAAremotecustomer servicecommunicationdocumentationdata trackingwork from homeadministrative supporthealth planclaims analysis
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