Position: Claims Analyst

Job Type: Full Time

Department: Health

Location: HOLLYWOOD

Posted: 08/01/2023

Job Description

The incumbent in this position is responsible for reviewing, analyzing, and monitoring medical and dental documentation submitted to the Seminole Tribe Health Plan for payment. The individual maintains records and prepare reports and correspondence related to health claims, including analyzing payments, procedures and guidelines to coordinate benefits, eligibility and cost containment. The individual investigates the validity of health claim information provided to the Tribal Health Plan, such as eligibility, referrals, pre-certifications, subrogation cases and other coordination of insurance. The individual provides guidance to Tribal Members and providers on health insurance claims to include responding to status inquiries. Bachelor’s degree in Health Administration, Accounting, Business Administration or related field is required. A minimum of three (3) years of experience working as Health Claims Analyst or experience processing and submitting insurance claims is required; or an equivalent combination of education/training and experience will be considered. Coding credential preferred but not required. Possession of a valid Florida Driver’s License is required. Demonstrate excellent customer service and organizational skills. Demonstrate excellent written and verbal communication skills. Demonstrate proficiency utilizing Microsoft software packages. Ability to work a flexible schedule including evenings, weekends and holidays.

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