Claims Analyst

Aspire Health Plan

Coastal TPA

Full Time

Day shift

Mon-Fri, Days



High School Diploma/GED Required

The Claims Analyst is responsible for processing health insurance claims in accordance with the terms of individual benefit contracts.

• Process medical, dental, and vision claims.
• Code medical procedures, diagnoses and supplies.
• Coordinate benefits with other group health plans.
• Interpret plan documents and apply plan benefits based on that interpretation.
• Verify eligibility and authorization.
• Refer appropriate claims, pre-certifications and appeals to management and/or medical review.
• Request necessary documentation from providers and/or insureds.
• Assist in the investigation of possible fraudulent claims.
• Investigate injury cases for third party liability or workers' compensation.
• Perform other duties and functions as assigned

• High school diploma or equivalent.
• Experience in the processing of health insurance claims or equivalent practical experience in a medical office.
• Knowledge of medical terminology, insurance billing and coding.
• Ability to operate software programs and computer equipment required to fulfill position responsibilities.
• Ability to problem solve.
• Able to conduct oneself in a professional manner.

Equal Opportunity Employer