Medical Claim Analyst

This is a Fully Remote Job
About Our Client:
The organization operates within the healthcare industry, focusing on creating a connected and compassionate health experience. It addresses the challenges of simplifying healthcare access and delivery for individuals, families, and communities through coordinated care and quality prioritization.
About the Opportunity:
The MEDICAL CLAIM ANALYST role is designed to manage the initial review and triage of medical claims, ensuring accurate coverage determination and eligibility verification. This position supports medical staff by preparing authorizations and directing cases appropriately, playing a critical part in maintaining regulatory compliance and efficient claims processing to improve healthcare service delivery.
Responsibilities:
Review and triage claims requiring evaluation
Determine coverage eligibility and redirect misdirected claims
Prepare authorizations in the system and triage cases to medical staff
Prioritize workload to meet regulatory and turnaround time requirements
Facilitate communication to enhance medical management services
Perform non-medical research and support tasks
Comply with policies and regulatory standards
Maintain accurate documentation meeting risk and accreditation requirements
Protect confidentiality of member information
Assist in researching and resolving claims payment issues
Requirements:
Effective communication and organizational skills
Familiarity with basic medical terminology and care concepts
Strong customer service skills for coordinating service delivery
Proficiency in computer applications including Excel and Word
Ability to work from a quiet, secure home office with required internet speeds
Competence in using multiple monitors and navigating digital communication tools
Experience with Microsoft Office 365 or similar platforms
Ability to manage system security and troubleshoot technical issues
High School Diploma or G.E.D
Preferred: 2-4 years experience as medical assistant, office assistant, or claim processor; certifications such as CEC/GPS or MedCompass
Pay Range and Compensation Package:
The typical pay range for this role is $18.50 to $35.29 per hour
This position is eligible for bonuses, commissions, or short-term incentives in addition to base pay
Benefits & Perks:
Medical insurance
Dental insurance
Vision insurance
401(k) retirement plan
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Skills
Excel, Regulatory Compliance, Documentation

Experience
2-4 yrs

Work arrangement
Yes