Claims Call Center Analyst

Located in Grants Pass, OR

Salary: $20-$22 DOE

Claims Call Center Analyst

About the Role

Our client, a leading healthcare organization dedicated to improving the provider and member experience, is seeking an experienced Claims Call Center Analyst I to join their dynamic team. This role serves as the primary point of contact for provider offices, handling high volumes of incoming calls and email inquiries with professionalism, accuracy, and efficiency.

The ideal candidate will bring strong medical claims processing experience, AAPC certification (Certified Professional Coder), and proficiency with EZ Cap software. This position offers a collaborative, fast-paced environment where attention to detail, communication, and problem-solving skills are essential.

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Key Responsibilities

• Serve as the first point of contact for provider offices, responding promptly to inbound calls and portal emails.

• Accurately document all communications within the core claims system and ensure timely issue resolution.

• Review and reprocess claims as appropriate, ensuring accuracy and compliance with company policies and regulatory guidelines.

• Process professional claims in accordance with benefit rules, contract terms, and applicable Medicaid/Medicare standards.

• Apply coordination of benefits (COB) policies to ensure correct claims payment.

• Identify errors or inconsistencies in claims and take corrective actions.

• Maintain a 95% same-day call resolution rate while meeting production and quality standards.

• Collaborate effectively with internal teams to escalate and resolve complex issues.

• Ensure compliance with HIPAA and all applicable company and regulatory requirements.

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Qualifications

Required:

• AAPC Certification (Certified Professional Coder – CPC).

• Medical claims experience – minimum 1 year in claims processing, call center, or healthcare operations.

• Proficiency in EZ Cap (or similar claims management systems).

• Strong understanding of medical terminology, ICD-10-CM, CPT, HCPCS, and claim forms (CMS-1500, UB-04).

• Excellent communication, documentation, and customer service skills.

• High level of accuracy, organization, and attention to detail.

Preferred:

• Experience in a managed care or Medicaid/Medicare environment.

• Familiarity with coordination of benefits, HIPAA compliance, and provider relations.

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Education

• High school diploma or GED required.

• AAPC certification required (or must be obtained within 12 months of hire – company sponsored).

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Additional Information

• No on-call responsibilities.

• Standard business hours; rotating phone schedule may apply.

• Opportunity for advancement upon certification completion and demonstrated performance.

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