• Job Description

  Req#: 110749

  Job Details

  Level: Entry

  Job Location: TRG HeadQuarters - La Grange, KY

  Position Type: Full Time

  Education Level: High School

  Salary Range: Undisclosed

  Travel Percentage: None

  Job Shift: Day

  Job Category: Insurance

  Job Summary

  Job Summary

  A Payment Integrity Analyst is an integral part of a dynamic team. Analysts utilize claims systems and established resources to determine coordination of benefits and potential claim overpayments for members covered by more than one health coverage. Extensive phone outreach to members, employers, providers, and insurers is often needed to make this determination. The Analyst also handle tasks including, but not limited to, invoice preparation, invoice follow-up, and file maintenance.

  Hours : Day shift, 40-hour work weeks. During training, 8am - 5pm. Flexible schedule options available between 7am - 7pm after six months of employment.

  Setting : Professional office environment (with remote opportunity available after six months of employment based on performance).

  Compensation: This is an exempt position at a very competitive salary, $47,000 with significant bonus opportunity. Top 20% of our Analysts earned $85,000+ last year. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more. We also offer an onsite gym, cafe, and coffee shop.

  Training: The Rawlings Company takes great pride in providing exemplary training and development programs via in-person instruction. Training covers our state-of-the-art proprietary systems, Medicare and Commercial primacy rules, communication strategies, and many other tools to place Analysts on the path to success.

  Responsibilities

  • Reviews and audits healthcare claims to ensure claims payments coordinated properly, utilizing Medicare and Commercial primacy rules.
  • Effectively communicates with healthcare providers, employers, members, and/or insurance representatives to gather information.
  • Resolves issues in a timely fashion.
  • Utilizes available resources to maximize identification and recovery of overpayments.
  • Creates, maintains, and closes files in accordance with policies and guidelines.
  • Delivers world class customer service and maintain professionalism in all aspects of communication.
  • Actively seeks to identify process improvements to increase workflow efficiency.

  Qualifications

  • Bachelor’s Degree or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.
  • Very strong attention to detail, deductive reasoning, and organizational skills.
  • Excellent oral and written communication skills, including on the phone, are required.
  • Demonstrate integrity and honesty in all aspects of job performance.
  • Ability to work well independently or in a team environment.
  • Customer service experience highly preferred.
  • Working knowledge of Word and Excel is required.
  • Demonstrate integrity and honesty in all aspects of job performance.
  • Experience in the healthcare field is helpful, but not required.

  Physical Requirements

  • Frequently remains in sitting position for long periods of time to perform duties.
  • Frequently concentrates for long periods of time, paying close attention to detail.
  • Frequently uses and views the computer using fingers, hands, and vision.
  • Frequently works in a well-lit, tempered environment.
  • Occasionally moves through office to communicate with other employees

  Our Company

  
  

  The Rawlings Group is looking for hard-working, talented people who share our commitment to excellence to join our company. The Rawlings Company has successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader.

  Our Culture is focused on:

  • The guiding principle of doing the right thing
  • Caring for our employees and taking pride in the work they do
  • Providing recognition and financially rewarding employees for their success

  Our Values are:

  • Integrity and Trust
  • Customer Service Excellence
  • Innovation
  • Diversity and Inclusion
  • Honoring our Veterans and Their Service

  
  *Equal Employment Opportunity. It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
  *The Rawlings Group is an employment at will employer.

  #LI-CL0

  #INDHP

  
  

• About the company

  The Rawlings Group has an unbeaten record of recovering more money for more health plans than any other vendor. Contact us today.

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