Salt Lake City, UT or Lewiston, ID
Bring your claims expertise to this role where you will: * Process a variety of claim types and
product lines to maintain the complete claims processing cycle for multiple functions/edits.
Pre-Payment Fraud Analyst I monitors claims process and communicates across multiple divisions while working under minimal supervision.
Pre-Payment Fraud Analyst II develops reports by compiling claims processing data for management review.
Key qualifications and experience needed for success:
* Demonstrates the ability to apply critical thinking skills.
• Demonstrate understanding of medical terminology and ICD-9/10 CPT coding.
• Provide excellent customer service to customers, providers, members, brokers, member representatives and all levels of internal staff.
• Computer experience and familiarity with software, such as MS Word and Excel, or other comparable programs.
• Ability to work independently as well as a member of a team.
• Ability to work under pressure and meet deadlines. Must be highly adaptable and flexible with workload based upon the EAID goals/priorities.
• Communicate effectively orally and in writing. Ability to communicate complex claims processing information in writing when responding to internal customers regarding issues/questions.
• Excellent interpersonal skills and the ability to work with all levels of staff.
• Ability to organize and prioritize workload and to meet deadlines.
• Demonstrate strong analytical ability in identifying problems and strong skills in performing in-depth investigation, judgment in developing solutions and implementing a course of action.
• Meet job quality, quantity, timeliness, knowledge, and dependability requirements as described by department goals.
• Demonstrates a high degree of job knowledge with the ability to learn and retain information in multiple processing systems.
• Excellent claims processing skills.
• Strong attention to detail and consistent high quality of work.
Additional Requirements for Pre-Payment Fraud Analyst II
* Demonstrates in-depth problem solving skills. Can effectively communicate across multiple divisions and work under minimal supervision.
• Demonstrates a high degree of job knowledge on multiple complex or specialized claim types.
• Demonstrates effective communication and leadership skills across the division.
• Ability to quickly learn and retain claims processing procedures and guidelines for multiple processing systems.
• Ability to create reports for management.
Normally to be proficient in the competencies listed above:
* Pre-Payment Fraud Analyst I would have high school diploma or equivalent and 3 years of claims experience or equivalent combination of education and experience.
• Pre-Payment Fraud Analyst II would have high school diploma or equivalent and 4 years of claims experience or equivalent combination of education and experience.
The position is pay levels 11 or 12 depending on experience.