Senior Claims Response Analyst

March 26

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

💵 $45k - $50k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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Guide Healthcare

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Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

Physiotherapy • Podiatry • Speech Pathology • Dietetics • Recruitment

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🎯 Recruitment

📋 Description

• The Sr. Response Analyst role is responsible for the investigation of the referral/authorization episodes to determine approval or non-approval and respond accordingly to the Home Plans requests. • Reviewing and finalizing 095 and PDC reports of claims sent to the Home Plan needing review and status of approval and or payment/denial. • Reviewing and responding to the email inquiries received from the Home Plans. • Reviewing and working on the reconciliations of members out of pocket maximums received from the Home Plans. • Reviewing and resolving Blue Cross, Grievances, and DOI appeals. • Reviewing and resolving claim inquiries from internal staff. • Assisting with other coworkers’ workflow as assigned by the department manager and lead. • Reviewing and working provider and member appeals. • Monitoring and assisting with Jira ticket inquiries. • Responsible for No Surprise Act estimates and respond to providers.

🎯 Requirements

• High School diploma or equivalent • Knowledge of both Medical Insurance claims processing and authorization/referral data. • Medical claims adjudication experience preferred. • Proficiency in Microsoft Office Applications, Excel proficiency • Experience with Microsoft Access • Excellent verbal and written communication skills • Strong attention to detail and commitment to quality • Ability to multi-task • Deadline oriented • Ability to work independently with minimal supervision

🏖️ Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered. • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution. • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected. • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. • Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals. • Support Your New Family: Guidehealth offers paid parental leave to give you the time you need. • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.