Healthcare Claims Analyst

Job overview

The Healthcare Claims Analyst role is an onsite, full-time position in Tallahassee, FL; compensation is not specified, though the posting describes pay as competitive. Capital Health Plan is a not-for-profit healthcare organization serving the Florida Panhandle. The analyst reviews and adjudicates claims to determine plan liability and ensure processing follows policies, provider agreements, and member benefits. The role supports accurate, timely claims operations by resolving issues, monitoring pending work, and progressing to more complex claims as proficiency develops.

What you'll do

• Analyze low- to moderate-difficulty insurance claims and determine plan liability
• review claims for errors or missing information
• evaluate payment under provider agreements and member benefits
• issue notifications for denied claims
• follow up on pending claims and collaborate with departments to resolve issues
• maintain processing statistics
• validate scanned and OCR claims and enter paper-claim information
• monitor pending volumes and notify the Claims Supervisor when limits are exceeded
• refer questionable claims for further evaluation. Schedule is Monday–Friday, 8:00 AM–5:00 PM, with willingness to work evenings, weekends, and overtime as directed.

What we're looking for

Skills & competencies

tallahassee fl

capital health plan

healthcare claims analyst

claims processing

claims adjudication

provider agreements

member benefits

ocr claims

medical terminology

monday-friday

8:00 am-5:00 pm

evenings and weekends as directed

Work arrangement

• Weekend coverage required

Benefits & perks

• Health and dental coverage, health and dependent care spending accounts, short- and long-term disability, major disability time off, retirement plan, life and AD&D insurance, paid time off, employee assistance program, and SmartDollar.

Why this role

Opportunity to progress to claims of greater complexity within six months, based on accuracy, speed, and ability.

About the employer

Capital Health Plan is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.