Claims Analyst
Employment type
Full-time
Work setting
On-site
Location
Wheeling, WV
Schedule
Day shift
Posted
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Job overview
The Claims Analyst role is onsite in Wheeling, WV. Compensation is not specified. The position works under the Manager of Claims at The Health Plan of West Virginia. The role reviews medical claims and claim edits against established criteria and payment guidelines, helping the plan process claims accurately and within required time parameters.
What you'll do
- Perform initial reviews of HCFA 1500 and UB 04 claims and claim edits
- complete or route reviews within established time parameters
- review claim flags in sequence against criteria and payment guidelines
- report billing or utilization patterns and unclear guidelines
- maintain a 98% quality rating and process 15–20 claims per hour
- attend training as requested.
What we're looking for
- Skills & competencies
- claims analystmedical claimshcfa 1500ub 04cpticd-10claims reviewwheeling wvthe health plan of west virginiafull-time position8:00am–5:00pm40-hour workweek
- Work arrangement
- Weekend coverage required
About the employer
The Health Plan of West Virginia Inc is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
- Occupation code
- 13-1031.00
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Listing ID: c0d472ce-2bd2-469a-9403-8f6fb094d4fa