Sr. Claims Analyst - Hartford, CT

We are seeking a highly motivated and detailed oriented Claims Analyst to join our team. This is a hybrid position requiring work in our Hartford, CT office a few days each month.

The hourly rate for this position is $17-21/hr.

As a Claims Analyst, you will play a critical role by investigating, evaluating and reviewing insurance claims to ensure accurate and timely resolution.

Key Job Role

• Reviewing Adjudicated claims:

• • Reviewing claims processing policies and guidelines.
  • Reviewing provider contracts.
  • Analyzing historical overpayment trends.
  • Analyzing claims data to identify outliers.
  • Review and access insurance claims to determine coverage, liability and eligibility.
  • Validate details such as claim ID, Date of service, refund amount and reason for the overpayment from image.
  • Validate claim in system and match all the information from images.

• Conduct thorough investigations, including gathering relevant documentation.
• Collaborate with internal departments, and insurance adjusters to gather necessary information.
• Calculate claims correct payment.
• Maintain detailed and accurate records of claims and related correspondence.
• Assist team members and as and when required.
• Maintain and track overpayment projects in organized and timely manner.
• Adhere to all client and company policies without exceptions.

What you'll need:

• Expertise in US Health Insurance Claims Processing 
• Excellent communication skill for client interaction
• Good basic mathematics, reasoning, and interpretation skills
• Working knowledge of MS Excel for project delivery
• Basic understanding of SQL and VBA
• Experience in reporting and data analysis

Preferred Qualifications:

• US Healthcare experience
• Bachelor’s degree and equivalent work experience.
• Minimum 2-3 years’ experience in claims analysis or a related filed.
• Strong analytical and problem-solving skills
• Proficient in using claims management software and tools.
• Knowledge of insurance industry regulations and practices.
• Ability to work independently and as part of a team.
• Detail oriented with a high level of accuracy.
• Strong organizational and time management skills.
• Commitment to maintaining confidentiality and ethical standards.