About Us
For over 40 years, J.P. Farley Corporation has been delivering self-funded plans for medical, prescription, dental, vision, short-term and long-term disability benefits. Our team is dedicated to reshaping healthcare by realigning the interests of Employers, Employees, and Clinicians. We help patients connect with the highest quality provider when they are at their most vulnerable, removing risk and ambiguity from the decision-making process.
We are a privately held third-party administrator with a complete focus on Clarity, Connection, and Compassion.
Senior Claims Analyst
We are a rapidly growing Third Party Administer (TPA) of health plan benefits and we are looking to hire a Senior Claims Analyst to join our team! As a Senior Claims Analyst, you will be responsible for the timely and accurate processing of Medical, Dental, Vision, and Disability claims under multiple and varied contracts and plans. This includes researching situations for coverage, investigating to resolve coverage questions, and determining claim eligibility as it pertains to the plan.
Duties & Responsibilities:
- Independently analyze and review health care claims to ensure cost reasonableness, that the treatment provided by the physicians and hospitals was medically necessary, and for fraud.
- Review and analyze billed procedures and diagnostic codes for medical necessity, billing errors, and inconsistencies.
- Request records and notes from physician offices, hospitals, police reports, etc. and analyze for proper claims processing.
- Process claims and document all information gathered in our claims processing system, Virtual Benefits Administration (VBA)
- Determine whether the health plan provides benefits in connection with the submitted claim and the level of benefits to be paid to the provider. Review and apply claims processing criteria as provided in industry-standard or company specific claims administration policies/procedures. .
- Understand and comply with all company policies and procedures including HIPAA and privacy & security laws.
- Assist and support other team members when needed/requested.
- Communicate with providers, members and clients as needed to adjudicate claims or resolve claim inquiries.
Required Experience & Skills:
- A minimum of 5 years of medical claims analysis experience including dental and vision.
- Must have strong analytical skills and knowledge of CPT & ICD-10 coding terminology.
- Must be detail oriented with strong organizational skills
- Must be able to make independent determinations on claims
- Must have strong written and verbal communication skills
- Must maintain member confidentiality
- Must have working knowledge of coordination of benefits
Education:
- High School Diploma or equivalent required
- College Degree preferred
Why JP Farley?
- Work from home (may require onsite training)
- Opportunity to make positive change while directly impacting people who need assistance.
- Room for advancement and growth for all employees
- A challenge awaits you every day making boredom impossible.
- Our passion to change healthcare administration will leave you with a sense of accomplishment and pride in what you do.
- Rewarding work that has a tangible and measurable impact.
- Small business mentality, but a stable and growing company where people are passionate about people.
- Fair, just, caring and understanding leadership that empowers employees.
- Open communication where everyone's opinion is heard, and everyone is valued.
- System capability, very new and intuitive technology
- Fun perks: Employee Appreciation Day, regular company lunches, dog-friendly office, and more
- Great culture where people care.
- Honest, open, and fun workplace.
- Strong, collaborative team environment where every employee is respected and appreciated.
- Great location with easy access to freeway and restaurants
Benefits: Healthcare, Dental, and Vision Insurance; 401K & 401K match; PTO and Vacation; Paid Holidays; Dog friendly office; Company provided lunch each pay day; Remote work.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Education:
- High school or equivalent (Required)
Experience:
- claim analysis/examining: 5 years (Required)
Work Location: Remote