Claims Analyst

Remote

Full Time

Mid Level

Job Title: Claims Analyst
Compensation Expectations: $19.00-$22.00 per hour DOE
Role Location: Tampa, FL or Remote

Marpai Administrators (Subsidiary of Marpai Inc.) is a technology company transforming the Third-Party Administration sector serving employers with self-funded health plans. Marpai Administrators (“Marpai”) is an AI-powered national TPA (third party administrator) using deep learning and machine learning to maximize population health outcomes with the greatest cost efficiency for any health plan budget. We create healthier members and a healthier bottom line. Marpai proactively targets at-risk members with meaningful clinical interventions to improve outcomes.

ABOUT THE POSITION:

We are expanding our Claims Team! The Claims Analyst reports to the Director Claims and will be responsible for reviewing claims for accuracy, completeness, and eligibility. The Claims Analyst is responsible for adjudicating claims, completing work assignments and meeting established departmental metrics.

WHAT YOU WILL BE DOING:

Accurately input claims data into the system, ensuring all information is complete and correctly recorded.
Review, analyze, and adjudicate claims in accordance with company policies and regulatory requirements.
Validate claim information to ensure completeness and accuracy, addressing any discrepancies or missing data.
Interpret and apply benefits in accordance with the plan document to ensure correct processing of claims.
Manage and maintain claim inventories in compliance with health plan and regulatory policies.
Demonstrate professionalism, composure, and the ability to perform effectively under pressure and tight deadlines.
Complete daily assignments promptly, updating relevant spreadsheets and tracking progress.
Provide an end-of-day summary to management, detailing completed tasks and pending items.
Adapt to changing priorities and work assignments as directed by management to meet organizational needs.
Consistently meet departmental standards for quality, productivity, and attendance.
Exhibit flexibility and willingness to work overtime as needed to meet business demands.
Remain current on trends and industry knowledge establishing self as subject matter expert
Other duties as required

WHAT SUCCESS LOOKS LIKE

Goal of role - to ensure the timely, accurate, and compliant processing of claims in alignment with the organization’s policies, health plan benefits, and regulatory requirements. This role aims to deliver high-quality service by thoroughly reviewing, adjudicating, and validating claims data to minimize errors and optimize claims accuracy. The ultimate objective is to ensure a seamless claims experience for clients and stakeholders, while maintaining strict adherence to HIPAA and regulatory standards.
Success can be measured through a variety of performance metrics that reflect both the efficiency and quality of claims processing, as well as adherence to compliance standards.
By ensuring accurate claims processing, minimizing errors, and improving cycle times, the Claims Analyst helps to control costs, reduce risks, and enhance service delivery. Ultimately, these contributions lead to stronger client relationships, improved profitability, and business growth.
Success within the team is measured by collaboration, communication, problem-solving abilities, and contributions to team productivity, morale, and performance. Success is also determined by the ability to adapt to changing business needs, mentor colleagues, and drive improvements in operational efficiency.

WHAT DO YOU NEED

Associate’s degree, preferred
2+ years claim processing experience
Strong analytical, research, and communication skills, with the ability to synthesize complex information and present it clearly.
In-depth knowledge of medical terminology, enabling accurate claim analysis and adjudication.
Exceptional verbal and written communication skills, coupled with outstanding organizational abilities.
Collaborate effectively with leadership to identify and address emerging trends and issues within the claims process.
Demonstrated ability to make independent decisions and solve problems in a timely and effective manner.
Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook) at an intermediate or higher level.
Strong multitasking skills with the ability to anticipate needs and proactively address potential issues.
Meticulous attention to detail, ensuring accuracy and quality in all tasks.
Ability to understand, apply, and adhere to online documentation policies and procedures.
Excellent customer service skills, with a strong sense of ownership and commitment to completing tasks with follow-through.
Capable of managing a high volume of work, solving complex problems, and prioritizing multiple assignments while meeting critical deadlines.
Knowledge of HIPAA regulations and a commitment to maintaining compliance with privacy and security standards.

WORK REQUIREMENTS:

Remote
Fast paced, dynamic work environment requiring the ability to be adaptive, innovative and flexible
No travel required
Quiet work environment

WHY WORK AT MARPAI?
We have great benefits:

Generous PTO
Medical and Prescription
Health and Wellness Programs
EAP
FSA / HSA / Dependent Care
Dental
Vision
Life and Disability
STD/LTD
Voluntary Benefits: Critical Illness, Accident, Hospital
401k with Employer Match
Pet Insurance
LegalShield
Identity Theft Protection

Marpai is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.

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