Claims analyst
- Location
- Omaha, NE · On-site
- Job type
- Contract
- Level
- Mid-level
- Education
- High school diploma or equivalent
- Listed
- 30 days ago
Skills & highlights for this role
- claims adjudication
- medical terminology
- claims processing systems
About the role
Job Title: Claims analyst Location: Omaha NE 68154 Duration: 12 months
About the role
Family Summary/Mission Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/Mission Reviews and adjudicates routine claims in accordance with claim processing guidelines.
Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions) * Analyzes and approves routine claims that cannot be auto adjudicated. (*) * Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*) * Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. * Routes and triages complex claims to Senior Claim Benefits Specialist. (*) * Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*) * May facilitate training when considered topic subject matter expert. (*) * In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*) * Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*) Performance Measures Background/Experience Desired * Experience in a production environment. * Claim processing experience.
Qualifications & Requirements
Education and Certification Requirements High School or GED equivalent. Additional Information (situational competencies, skills, work location requirements, etc.) * Ability to maintain accuracy and production standards. * Analytical skills. * Technical skills. * Oral and written communication skills. * Understanding of medical terminology. * Attention to detail and accuracy.
Additional Information
All your information will be kept confidential according to EEO guidelines.
About the Company
Integrated Resources Inc.
From Integrated Resources Inc.'s careers page, first listed on Rolev.ai on October 10, 2026. Rolev.ai is not the employer.
How Rolev.ai helps with this application
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Common questions
Where is the Claims analyst job at Integrated Resources Inc. located?
This Claims analyst position at Integrated Resources Inc. is located in Omaha, NE (On-site). Always check Integrated Resources Inc.'s application page for specific state eligibility or relocation policies.
What qualifications are required for Claims analyst at Integrated Resources Inc.?
For the Claims analyst role, Integrated Resources Inc. highlights a high school diploma or equivalent; experience with claims adjudication, medical terminology, claims processing systems. Rolev.ai can score your existing resume against these requirements and show any skill gaps before you apply.
How do I apply for the Claims analyst position at Integrated Resources Inc.?
This listing links directly to Integrated Resources Inc.'s SmartRecruiters application page. You can apply directly on Integrated Resources Inc.'s site, or use Rolev.ai to check your resume fit, generate a zero-hallucination tailored resume and cover letter for this posting, and autofill the SmartRecruiters application form in 1 click with the Rolev.ai Chrome extension. You always review the form and press Submit yourself.