Medical Policy Analyst

Yesterday

🇺🇸 United States – Remote

🦌 Connecticut – Remote

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

🏖️ New Jersey – Remote

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

+2 more states

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $76.8k - $102.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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NJM Insurance Group

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Auto Insurance • Workers'​ Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance

1001 - 5000 employees

Founded 1913

Description

• Responsible for medical policy determination of claims/cases consistent with Plan Medical Policy • Provide timely and accurate responses to inquiries from the claim policy teams • Prepares cases for Medical Director Review and or outside consultant review • Responsible for processing pends for which the Medical Policy Inquiry Resolution team has authority • Identifies opportunities for development of or revisions to Horizon Medical Policy based on case review • Responsible for documenting production in RMRS and following through on inquiries • Responsible for staying abreast of all mandates, policy and workflow changes • Performs special projects as assigned by management • Demonstrates knowledge and understanding of laws, regulations and policies

Requirements

• High School Diploma or GED equivalent required • Prefers a Bachelor Degree from an accredited college or university • Requires a minimum of 2 years clinical experience • Requires 3 years’ experience in the health care delivery system/industry • Active Unrestricted RN License Required; NJ License Preferred • Prefer Certified Professional Coder credentials.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement