Sr Claims Research Analyst - Pfs Claims Processing - Sharp Corporate - Day Shift - Full Time

Sharp Corporate

Base: $30.370 - $42.510 hourly; bonus/equity: not ...
Onsite
15+ years claims examiner experience
3 years supervisory responsibilities
Managed care environment expertise
Sharp Corporate is seeking a Sr Claims Research Analyst to handle complex health plan issues, including appeals and claims resolution. The position offers a full-time day shift with no weekend or on-call requirements

Job Summary

  • The role involves investigating and resolving complex health plan issues such as appeals, grievances, and claims resolution related to member and provider disputes.
  • Candidates must have at least 15 years of experience as a Claims Examiner in the insurance industry along with 3 years of supervisory responsibilities.
  • The position requires interacting with various internal departments and external health plan liaisons including Health Net, CIGNA, Anthem Blue Cross, and United Health Care.

Matching Summary

Match Score: 85

Sharp Corporate is seeking a Sr Claims Research Analyst to handle complex health plan issues, including appeals and claims resolution. The position offers a full-time day shift with no weekend or on-call requirements.

Salary

Base: $30.370 - $42.510 hourly; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • 15+ years claims examiner experience
  • 3 years supervisory responsibilities
  • Managed care environment expertise
  • Medical terminology proficiency
  • ICD-9 CPT HCPC coding knowledge

Nice-to-have

  • Associate's degree preferred
  • Strong analytical problem-solving skills
  • Excellent verbal communication abilities
  • Independent research decision making
  • Team leadership and training support

Key Requirements

  • H.S. Diploma or Equivalent
  • 15 Or More Years experience as a Claims Examiner
  • 3 Years experience with supervisory responsibilities
  • Evidence of completion of Medical Terminology class (Preferred)

Work Rights

Not specified

Tailored Resume

Cover Letter