Claims Analyst I (US Remote) at Trend Health Partners in Remote

Summary: TREND Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare. The Claims Analyst I will be responsible for identifying, analyzing, and recovering claim overpayments for clients, ensuring accuracy and timely completion of all related activities. Responsibilities: - Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures - Assist client in identifying, validating, and recovering claim overpayments - Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s) - Review and resolve disputed overpayments from client/provider - Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications - Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts - Ideate, test, document & submit new overpayment trends/research scenarios - Research potential new ideas and follow algorithm development process - Assist Management with concept approval information needed for client approval on specific trends - Always represent TREND and our clients in a professional manner - Cooperate with team members to meet goals and complete tasks in an efficient and effective manner - Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas - Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions - Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship Required Qualifications: - Bachelor's degree in accounting, business, healthcare, or a related field. Equivalent work experience in a similar position may be substituted for educational requirements - Excellent computer skills and proficient in Excel - Strong analytical skills - Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers - Attention to detail - Proven problem-solving abilities - Excellent written and oral communication skills - Effective organization, time management skills - Highly analytical, self-motivated, and directed - Must be able to learn, understand, and apply new technologies - High School Diploma or Equivalent Required Preferred Qualifications: - Proactive, independent and results oriented - Customer and team focused with a strong desire to be an active, long-term participant in the growth of the firm overall - Experience with medical claims processing - Experience in identification, analysis, and recovery of claim overpayments Required Skills: Claims analysis, Medical claims processing, Claim overpayment identification, Claim overpayment recovery, Excel, Computer skills Benefits: Health insurance, 401(k) plan with employer match, Paid parental leave, And more