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Health Insurance Claims Analyst

  • Location: Durham, 27707
  • Salary: 50.0
  • Job Type:Contract

Posted about 2 months ago

Our Healthcare Insurance client is seeking a Senior Health Insurance Claims Analyst to join their team for a contract role!

Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers. Health care is changing, and our client is leading the way by provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.

Position: Senior Health Insurance Claims Analyst
Term: 6 + Months
Location: Remote, USA

Required Skills 

  • Amisys knowledge
  • Macess knowledge
  • SMA (Senior Market)-knowledge or experience
  • Undergraduate degree with 2 years application/systems analysis experience (i.e. testing, project team work related to system functionality/process development).  If no degree, 4 years application/systems analysis experience or 6 years experience in relevant business function developing strong technical skills with associated applications/systems
  • Some knowledge or experience with automated tools to perform analysis and reporting (i.e. Business Objects, query writing) 

Desired Skills 

 
  • Ability to read, interpret and manage trouble tickets
  • Commitment to excellent customer service.
  • Strong analytical and problem-solving skills, including ability to interpret and effectively present quantitative data.
  • Ability to manage multiple priorities and meet deadlines.
  • Process focused
  • Solid PC skills with MS Word, Excel and PowerPoint.

Description:
The Claims division of this health insurer works with the Sr. Market (Medicare). They are moving from one claims system to another. These two positions will specifically support Amisys and Macess.  Two contractors will continue to support the work on the existing platforms (Amisys and Macess) that will be replaced in 2024. This team works of of trouble tickets where a claim needs to be reviewed, investigated and resolved. May have to query the claims system for similar issues. Other key attributes: Analytical, Ability to work independently and manage your own projects, and work in fast paced work environment. 

Technical Support/Business Expertise

  • Provide technical knowledge and support in operational system/application and procedural issues to the business and IT and help the business find technical solutions to meet their goals.
  • Work in some phases of systems analysis and consider the business implications of the application of technology to the current business environment
  • Provide ongoing user support for ad hoc questions, inquiries, and service requests.
  • Provide timely and accurate reporting/data on inventory, productivity, user activity, and system performance on a regular and/or as requested basis.

Issue Resolution

  • Resolve medium, moderately complex production issues by:
  • Performing initial triage for severity and business impact of system/application failures.
  • Troubleshooting and analyzing to determine root cause of issues
  • Developing applicable business processes and solutions to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.
  • Coordinating with IT, other teams and vendors as needed to communicate issues and devise and implement long term remedies.
  • Develop system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities

Project/Program Support

  • Work collaboratively on projects and initiatives with the business and IT by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application.
  • May act as Business Lead/Coordinator on moderate single area/department projects.

****To be eligible to contract at this client you must be able to pass a drug test and criminal background check.

Candidates will be responsible for following the client's COVID-19 protocols. Please refer to your MATRIX representative for specifics.

About Us

At MATRIX, we expertly match talented professionals with job opportunities to elevate careers. Since 1983, we have placed thousands of professionals at innovative clients across every industry ranging from small startups to Fortune 50 companies. It’s why we’re consistently in the top 25 of all U.S. IT staffing firms and why our consultants rate us well above the industry average, earning us ClearlyRated's Best of Staffing awards year after year. People come to us for a job, and stay with us because of our top-notch consultant care.

MATRIX is and Equal Employment Opportunity employer including disability and veteran and provides reasonable accommodations for all qualified individuals.  Supporting medical or religious documentation will be required where applicable. If you are a qualified individual you may request a reasonable accommodation under the American Disability Act (ADA). If you are a person with a disability needing assistance applying, or at any point in the hiring process, please email us at MATRIX_HR@MatrixRes.com. To ensure a quick response to your request, please use the words “Accommodation request” as the subject line of your email.

For hourly W2 contract roles MATRIX offers a highly competitive benefit package including Medical, Dental, Vision, Life, Disability, HSA, and 401(k) with pre and post-tax options.  Please see MatrixRes.com/Benefits for more information.

For direct hire placement with our clients, benefits would be offered in accordance with that particular client’s offerings. This may include PTO, Medical, Dental, Vision, 401K and other pre and post-tax options.