Healthcare Claims Business Analyst

Support BlueCard operations by analyzing medical claims issues, identifying root causes, coordinating claim resolutions, and improving claims processing through data, technology, and process changes. Partner with processing, configuration, and account management teams; document procedures and represent the department in projects and meetings.

Responsibilities

• Analyze claim issues and inquiries and identify processing errors or inefficiencies.
• Perform root cause analysis on incorrectly processed claims and resolve identified issues.
• Coordinate with other health plans and internal teams to repair claims and address discrepancies.
• Recommend process improvements, system enhancements, and processor re-education.
• Use data, bots, applications, and other tools to improve claims processing.
• Document processes and procedures and represent the department in meetings and projects.

Required Skills

• Medical claims processing and adjustment
• Healthcare administration
• Blue Squared application
• Blue
• Card product knowledge
• Medical billing codes: ICD-10, CPT, and HCPCSClaims processing software
• Claims data analysis
• Root cause analysis
• Data summarization and pivoting
• Business process evaluation and improvement