Claims Analyst

Full Job Description

RiskOne HR Consulting is looking for a Claims Analyst for the Metro Area.
Minimum of two years of experience working claims in a Health plan or pharmacy benefit manager
Experience with Medicare Part D Manuals and Standards and with prescription drug events
Bachelor’s Degree in finance, Information Technology or Healthcare related field.
Responsible for conducting quality check and reviews of Medicare Part D claims samples on a routine basis to ensure proper parameter
Responsible for the calculation and creation of adjustment claims for processing based upon technical, clinical and client eligibility errors.
Responsible for the creation and updating of compliance submission calendar based upon CMS standards and processes for timely submissions and error working.
Create, suggest, develop, and implement new reporting for clients for PDEs.
Communicate and analyze guidance related to PDEs to ensure system setting and processes meet standards or requirements.
Knowledge in NCPDP Claims transactions standards and fields
Bilingual (English/Spanish)

Job Type: Full-time
Benefits:
Health insurance

Schedule:
8 hour shift

Experience:
Medicare: 2 years (Preferred)
claims analyst: 2 years (Preferred)

Education:
Bachelor's (Required)

Language:
English (Preferred)