Claims Analyst

JOB DESCRIPTION

Insight Global’s client is seeking a detail-oriented Claims Analyst to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This individual will join a high-volume medical billing and revenue cycle team, focusing on insurance claim resolution, denials, AR follow-up, and collections across both in-network and out-of-network claims.

This person will be responsible for working outstanding insurance claims, troubleshooting denials, reviewing EOBs, following up with payers, and helping resolve aged receivables across both in-network and out-of-network claims. The ideal candidate has strong medical collections experience, understands how to read and interpret EOBs, and can confidently work claims from identification through resolution.

Day-to-Day Responsibilities
-Work a blend of AR follow-up, denials management, and medical collections based on daily claim volume, aging, and dollar amount.
-Review, interpret, and troubleshoot EOBs to identify claim issues, underpayments, denials, missing documentation, coding-related concerns, and payer-specific requirements.
-Follow up with insurance carriers through payer portals and phone calls to resolve outstanding claims and expedite payment.
-Manage both in-network and out-of-network claims, including claims impacted by No Surprises Act timelines and requirements.
-Prioritize aged receivables and high-dollar accounts while maintaining accurate documentation and claim notes.
-Review denials related to medical records requests, EDI rejections, coding issues, and payer processing rules.
-Partner with internal team members and trainers to ensure claims are worked accurately and consistently within department standards.
-Maintain patient and company confidentiality while ensuring all documentation is clear, accurate, and up to date.

Compensation:
$25 to $27 per hour.

Benefits:
-Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance
-401k and Profit sharing
-Paid Time Off
-Contribution to Health Benefits
-Company Discounts on Products & Services

REQUIRED SKILLS AND EXPERIENCE

-2+ years of medical billing, medical collections, AR follow-up, or denials experience.
-Strong ability to read and interpret EOBs; candidates should be comfortable walking through both in-network and out-of-network EOB examples.
-Working knowledge of insurance claim processing, payer follow-up, claim denials, adjustments, refunds, and outstanding AR.
-Experience working with in-network and out-of-network medical claims.
-Familiarity with CPT codes, ICD codes, medical terminology, and common billing forms such as CMS-1500/HCFA and UB-04.
-Ability to work a high-volume claims queue while balancing speed, accuracy, and quality of documentation.
-Strong communication skills for payer follow-up, internal collaboration, and documentation.
-Adaptable, team-oriented mindset with the ability to follow established processes and build on existing training.

NICE TO HAVE SKILLS AND EXPERIENCE

-Experience supporting surgical, specialty, or high-volume healthcare billing environments.
-Experience with payer portals and EDI claim rejection workflows.
-Familiarity with TriZetto or similar clearinghouse systems.
-Experience working claims for major commercial payers such as Horizon, Aetna, Cigna, or similar carriers.
-Out-of-network claims experience, especially with longer aging cycles or No Surprises Act-related follow-up.