Claims Analyst

Healthgram are seeking a detail-oriented and motivated Claims Analyst to join our team. In this role, you will be responsible for the end-to-end processing of medical claims, ensuring that every transaction aligns with specific plan documents and federal compliance standards. The ideal candidate thrives in a high-production environment and possesses the technical savvy to navigate complex pricing structures and digital documentation systems.

Please note that this position has a base salary plus incentive pay based on production.

What the Claims Analyst can expect:

• Claims Processing & Repricing: Process electronic and paper claims from the queue while meeting strict production and audit targets. This includes repricing non-CIGNA and anesthesia claims, managing case rate agreements, and handling DRG reviews.
• Compliance & Regulatory Alignment: Ensure all claims follow "No Surprises Act" guidelines (including QPA pricing) and maintain rigorous adherence to HIPAA regulations and internal claims procedures.
• Group & Ticket Management: Accurately manage assigned group correspondence and resolve inquiries via the Member Central ticket system. You will also be responsible for completing reinsurance reports within established deadlines.
• Documentation & Routing: Maintain a digital-first workflow by routing claims via daily reports and scanning/uploading all necessary backup into Docuphase.
• Team Collaboration: Actively participate in monthly team meetings and provide coverage/backup for fellow Analysts to ensure no backlog builds up.

What the ideal candidate will bring:

• At least one year of experience processing claims.
• High school diploma or higher.

Pay: $18.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Please take 10 minutes to complete our personality survey using this link: https://go.cultureindex.com/s/tWoXx1CSDv

Education:

• High school or equivalent (Preferred)

Experience:

• claims processing: 1 year (Required)

Ability to Commute:

• Charlotte, NC 28217 (Required)

Work Location: Hybrid remote in Charlotte, NC 28217