Modivcare is a healthcare services company that helps people manage complex care needs through non-emergency medical transportation, personal care, virtual and remote patient monitoring, chronic care management, meal delivery, and in-home assistance. Its services support Medicaid and Medicare Advantage plans, state agencies, health systems, healthcare professionals, and transportation providers. By combining technology, data, and coordinated support, Modivcare works to address social determinants of health and help members access essential services and maintain continuity of care.
Claims Analyst III
Modivcare is hiring a remote Claims Analyst III in the United States to audit claims, resolve payment discrepancies, and improve claims systems. The role handles complex claim issues and includes mentoring junior team members.
Description
- Put claims processes in place to improve efficiency and accuracy
- Check claims data entered into the system for accuracy
- Track claims system performance
- Resolve claims issues and work with systems design teams to implement new features
- Check claims for irregularities, accuracy, and completeness
- Request any additional information needed to process claims
- Manage documentation, invoice disputes, and account payments
- Analyze accounts and investigate payment or account discrepancies
- Verify transactions and speed up claims issue resolution
- Resolve complex issues, escalating only the most difficult cases to higher-level staff
- Guide, coach, and mentor junior team members
- Take part in other projects and duties as assigned
Requirements
- Bachelor’s degree, or an equivalent combination of education and experience
- More than five years of experience
- Strong knowledge of claims processing and sound judgment when assessing claim eligibility
- Careful attention to detail and accurate data entry skills
- Intermediate skills with Microsoft Word, Excel, and Outlook
- Analytical ability to interpret claim data and follow established guidelines
- Strong verbal and written communication skills with a customer-focused approach
- Problem-solving skills to address claim issues and resolve discrepancies
- Ability to work both independently and as part of a team
- Typing speed of at least 35 words per minute and 10-key proficiency
Benefits
- Medical, dental, and vision insurance
- Employer-paid basic life insurance and accidental death and dismemberment coverage
- Voluntary life insurance for employees, spouses, and children
- Health care and dependent care flexible spending accounts
- Pre-tax and post-tax commuter and parking benefits
- 401(k) retirement savings plan with company match
- Paid time off
- Paid parental leave
- Short-term and long-term disability coverage
- Tuition reimbursement
- Employee discounts on retail, hotels, food, restaurants, car rentals, and more