Job Information
CAI Claims Processor Analyst in Bismarck, North Dakota
Job ID Number
R4951
Employment Type
Full time
Worksite Flexibility
Remote
Job Summary
As a Claims Processor Analyst, you will review processed claims and inquiries to determine corrective actions, including adjusting claims.
Job Description
We are looking for a Claims Processor Analyst to investigate and process health insurance claims and coordinate benefits for the members of our client’s health plan. This position will be a full-time, remote contract through August 2025 with possible renewal/extension.
Due to our end client and project work, all candidates must be United States citizens.
What You’ll Do
Review processed claims and inquiries to determine corrective actions, including adjusting claims as necessary
Utilize enrollment, benefit, and historical claim processing information to take corrective action steps
Resolve claim edits, review history records, and determine benefit eligibility for services
Ensure accurate provider or practice selection for claims and verify the completeness and accuracy of claim information
Meet production and quality standards consistently
Participate in all required training sessions to enhance skills and knowledge
Escalate issues to supervisory levels as needed
Maintain precise records, including timekeeping, to ensure compliance and accuracy
Undertake additional tasks as assigned or requested to support team objectives
What You'll Need
Required:
High School Diploma/GED required
Experience in healthcare insurance is essential
Proficient in data entry and basic computer skills, including MS Office Suite
Strong customer service and communication abilities
Critical thinking skills with the ability to solve problems within established guidelines
Capable of navigating multiple systems simultaneously and taking direction effectively
Familiarity with administrative and clerical procedures, including word processing and file management
Detail-oriented with a focus on accuracy
Preferred:
Prior experience with Medical Insurance Claims Processing
Prior experience with Medicare/Medicaid
Physical Demands
Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state, and local standards
Ability to move about to accomplish tasks or move from one worksite to another
Regularly access low and high spaces that may be at irregular angles such as under a desk
Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor
Must be able to communicate with customers/team members over the phone and in person
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Reasonable Accommodation Statement
If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 – 8111.
Equal Employment Opportunity Policy Statement
It is the policy of CAI not to discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Employees and applicants of CAI will not be subject to harassment due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.