Soma Capital Portfolio Jobs

Claims Analyst



Posted on Wednesday, May 22, 2024

Curative is searching for a claims analyst to review claims for completeness and process per plan guidelines. Carries out all duties while maintaining compliance and confidentiality and promoting the mission of the organization.


  • Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives.
  • Documents clearly and concisely claims adjudication decisions in Claim Notes. Consults appropriate reference materials to verify proper coding.
  • Ability to interpret and apply plan guidelines while processing to ensure correct plan setup.
  • Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification.
  • Proactively identify processes and system problems than can be improved, to reduce rework and provide accurate payment upon original processing.
  • Maintains timely responses to appeals and reconsideration requests
  • Attends and participates in departmental training, functions, and meetings.
  • Ability to meet/ maintain the required accuracy and production standards after release from training.
  • Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures
  • Performs other duties, functions, and projects, as assigned, by team management.


  • At least 3-5 years of experience in claims adjudication, including PPO and/or Medicaid, ERISA, Medicare, Level Funded and Self-Funded Experience with various claim payment systems in processing hospital, mental health, dental and routine medical claims within given deadlines.
  • Excellent Working Knowledge of MS Access, Google Sheets and Excel required
  • Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
  • Experience processing claims on the HealthEdge System is preferred
  • Excellent computer and keyboarding skills, including familiarity with Windows
  • Excellent interpersonal & problem-solving skills.
  • Excellent verbal and written communication skills to communicate clearly and effectively to all levels of staff, members, and providers.
  • Ability to be focused and sit for extended periods of time at a computer workstation.
  • Ability to work in a team environment and manage competing priorities
  • Ability to calculate allowable amounts such as discounts, interest, and percentages


  • High school diploma or equivalent.