Job: Claims Analyst - Coastal TPA

This posting has expired and is no longer available.

Job Description

Aspire Health Plan

Coastal TPA

Full Time

Day shift

Mon-Fri, Days



High School Diploma/GED Required

The Claims Analyst is responsible for processing health insurance claims in accordance with the terms of individual benefit contracts.

* Process medical, dental, and vision claims.
* Code medical procedures, diagnoses and supplies.
* Coordinate benefits with other group health plans.
* Interpret plan documents and apply plan benefits based on that interpretation.
* Verify eligibility and authorization.
* Refer appropriate claims, pre-certifications and appeals to management and/or medical review.
* Request necessary documentation from providers and/or insureds.
* Assist in the investigation of possible fraudulent claims.
* Investigate injury cases for third party liability or workers' compensation.
* Perform other duties and functions as assigned

* High school diploma or equivalent.
* Experience in the processing of health insurance claims or equivalent practical experience in a medical office.
* Knowledge of medical terminology, insurance billing and coding.
* Ability to operate software programs and computer equipment required to fulfill position responsibilities.
* Ability to problem solve.
* Able to conduct oneself in a professional manner.

Equal Opportunity Employer


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