Sr Claims Review Unit Analyst

Mô tả công việc

  USHEALTH Group, Inc. is an insurance holding company primarily focused on individual health insurance for self-employed individuals and small business owners.  Products are distributed through career agent organizations that are wholly owned subsidiaries.  The Company’s goal is to combine the talents of its employees and agents to market competitive and profitable insurance products and provide superior customer service in every aspect of operations. The Claims Department of the corporate office has an opening for a Senior Claims Review Unit Analyst.  This full-time hourly position reports to the Manager of Claims.   Position Summary   This position investigates medical claims as requested by the Claims Department.  The duties include extensive research, written and telephonic correspondence and review of medical records and other documents for eligibility determination.  Other key job functions: Initiate various investigations such as pre-existing, accident claims, possible subrogation, workers comp, other insurance information, conditions excluded by endorsement and application misrepresentations. Request necessary documents from policyholders, providers and vendors Review and evaluate medical records, system notes, forms, and other documents to determine liability. Refer finalized investigations to appropriate areas in the company Log daily work Assist Customer Service department in supplying status information and rush requests.