Medical Claims Analyst
Remote /
Operations – Insurance Operations /
Full-time
/ Remote
Changing Healthcare For Good
At Angle Health, we believe the healthcare system should be accessible, transparent, and easy to navigate. As a digital-first, data-driven health plan, we are replacing legacy systems with modern infrastructure to deliver our members the care they need when they need it. If you want to build the future of healthcare, we'd love for you to join us.
The Role
Our Operations team is the beating heart of the company. As a Claims Analyst, you'll be responsible for processing, examining, and adjudicating medical claims for payment or denial in accordance and compliance with benefit plan designs, contracted rates, network agreements, regulatory requirements, and other policies and procedures. This includes the accurate and timely processing of all claims upon first receipt, resolving claims payment issues, and identifying root causes of claims processing errors. This is a cross-functional, data- and process-driven role where you'll collaborate on a daily basis with stakeholders across the operations team and the greater company in carrying out our one of our most mission-critical functions.
Operations team members are intellectually curious, multi-faceted individuals that don't just ask "what," but also "why." No two days are the same and each comes with a unique set of challenges and problems to be solved. You'll also have the opportunity and flexibility to develop a variety of skillsets across functions including claims operations, member and customer operations, provider operations, data management, sales, partnerships, contracting, and more.
*This role is based remotely with a preference for Salt Lake City.
Core Responsibilities
- Process and adjudicate major-medical healthcare claims timely and accurately per appropriate requirements, including but not limited to regulatory guidelines, company policies and procedures, contractual agreements, and benefit plan designs/configurations.
- Validate claims for payment, benefit levels, coding, history, cost-sharing, and edits to ensure accurate and timely processing
- Research, identify, resolve, and respond to inquiries from internal and external stakeholders regarding outstanding claims-related issues and identifies root causes of claim issues/deficiencies
- Notify leadership immediately when claims or other projects cannot be completed within the processing timelines
- Perform payment reviews and adjustments (e.g. as a result of retroactive effective date of contracts and/or fee schedule changes)
- Serve as the company's internal subject-matter expert on claims processing/administration and collaborate with technology teams to inform product/platform development
- Participate in product/platform testing and communicate bugs, issues, and any other feedback to the appropriate product owners
- Immediately escalate major claims issues (e.g. high-dollar claims, platform failures/outages, potential fraud, legal/compliance concerns, etc.) to the operations lead and/or appropriate member of the leadership/management team
- Learn new skills across various operational functions, grow personally and professionally, and be a true pinch-hitter for the team—assisting and filling in wherever the need may be
What We Value
- High School Diploma or GED required, Associate's or Bachelor's degree preferred
- 5+ years of recent experience processing medical claims for major medical health insurance plans at a small to medium-sized health carrier or third-party administrator (TPA) – important note: experience must specifically be in full-service health plan/major medical claims (i.e. individual/small group ACA products, fully-insured large group products, or as administrator for self-funded health plans); medical claims processing for life insurance, workers compensation, limited/supplemental health, medical/hospital indemnity, and other non-major-medical products are a plus but do not count
- Expert in ICD-10, CPT, DRG, and HCC coding (CPC, COC, CIC, CRC, or other medical coding certification preferred)
- Experience with administering claims according to various provider payment methodologies (e.g., capitation, fee-for-service, case rates, RVS pricing, Per Diem, DRG pricing, and other fee-for-service and value-based reimbursement methodologies)
- Proficient with Microsoft Excel, manipulating data, and using formulas
- Intellectual curiosity—surface level answers don't do it for you. You dive into the details and the data because you're not satisfied until you get to the root cause or attain a fundamental understanding of whatever it is you're working on
- Highly proactive and able to operate autonomously in a fast-changing environment
- A strong and dedicated work ethic—someone who takes pride in the quality and output of their work
- Startup experience (e.g. experience at a startup health plan or TPA) strongly preferred
- Low ego and a willingness to not only learn, but also teach, lead, and follow
- A passion for democratizing access to healthcare and disrupting the status quo
Bonus Points
- CPC, COC, CIC, CRC, or other medical coding certification preferred
- Familiarity with Virtual Benefits Administrator (VBA) claims system, Optum360/Encoder Pro, and Context4Healthcare UCR platform preferred
Because We Value You:
· Competitive compensation and stock options
· 100% company paid comprehensive health, vision & dental insurance for you and your dependents
· Supplemental Life, AD&D and Short Term Disability coverage options
· Discretionary time off
· Opportunity for rapid career progression
· Relocation assistance (if relocation is required)
· 3 months of paid parental leave and flexible return to work policy (after 10 months of employment)
· Work-from-home stipend for remote employees
· Company provided lunch for in-office employees
· 401(k) account
· Other benefits coming soon!
Backed by a team of world class investors, we are a healthcare startup on a mission to make our health system more effective, accessible, and affordable to everyone. From running large hospitals and health plans to serving on federal healthcare advisory boards to solving the world's hardest problems at Palantir, our team has done it all. As part of this core group at Angle Health, you will have the right balance of support and autonomy to grow both personally and professionally and the opportunity to own large parts of the business and scale with the company.
Angle Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Angle Health is committed to working with and providing reasonable accommodations to applicants with physical and mental disabilities.
