Angle Health

Health Insurance for Startups

Operations Analyst, Claims

Remote / Remote
Job Type
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Anirban Gangopadhyay
Anirban Gangopadhyay

About the role

A Life-Changing Company

At Angle, we believe the healthcare system should be accessible, transparent, and easy to navigate. As a digital-first, data-driven health plan, we are replacing legacy systems with modern infrastructure to deliver our members the care they need when they need it. If you want to change the future of healthcare, we'd love for you to join us.

The Role

The Claims Analyst is responsible for processing, examining, and adjudicating medical claims for payment or denial in a manner that maintains compliance and within Utah’s regulatory requirements while achieving claims service level objectives. This position is responsible for the accurate and timely processing of all claims upon first receipt. Resolves claims payment issues or provider inquiries and identifies root causes of claims payment errors. The Claims Analyst responds to provider inquiries/calls related to claims payments and collaborates with other departments and/or providers to successfully resolve claims-related issues.

Core Responsibilities

  • Follows established policies and procedures and uses available resources, such as provider contracts, Utah regulatory guidelines, claim policies, and benefit coverage to process and adjust claims
  • Adjudicates medical claims according to regulatory and company processing guidelines and contractual agreements
  • Validates claims for payment, benefit levels, coding, history, cost-sharing, and edits to ensure accurate and timely processing
  • Researches, identifies, resolves, and responds to inquiries from internal departments regarding outstanding claims-related issues and identifies root causes of claim issues/deficiencies
  • Notifies Claims management immediately when claims or other projects cannot be completed within the processing timelines
  • Performs payment reviews and adjustments due to retroactive effective date of contracts and/or fee schedule changes
  • Participates in system testing and communicates newly-identified and potential issues to Claims management
  • Attends and actively participates in daily, weekly, and monthly departmental meetings, training and coaching sessions
  • Maintains productivity and quality standards as defined by management
  • Communicates with other departments to resolve all claim-related issues
  • Contacts providers either telephonically or in writing for additional information to resolve or clarify submitted claims issues
  • Reviews, credits, and applies refund checks to ensure member and provider accounts are properly reconciled
  • Handles misdirected claims inquiries
  • This position also requires cross-functionality handling member/group enrollment, provider data and configuration, and credentialing job functions
  • Other related duties, as assigned

What We Value

  • High School/GED required
  • 1-3 years prior claims experience preferred
  • Knowledge of medical terminology, ICD-10, CPT, and DRG coding
  • Proficient with Microsoft Excel, manipulating data, and using formulas
  • Mathematical aptitude and analytical skills
  • Ability to research and investigate information using multiple sources and documented guidelines
  • Strong interpersonal skills
  • Excellent listening, verbal, and written communications skills
  • Excellent comprehension, reasoning, and decision-making skills

Bonus Points

  • CPC, COC, CIC, CRC, or other medical coding certification
  • Knowledge of different providers’ payment methodologies (i.e., capitation, fee-for-service, value-based, other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.)

Because We Value You

  • Competitive compensation and equity packages
  • Comprehensive health, vision & dental insurance
  • Unlimited paid time off
  • Opportunity for rapid career progression
  • Relocation assistance (if relocation is required)

Backed by a team of world class investors, we are a healthcare startup on a mission to make our health system more effective, accessible, and affordable to everyone. From running large hospitals and health plans to serving on federal healthcare advisory boards to solving the world's hardest problems at Palantir, our team has done it all. As part of this core group at Angle, you will have the right balance of support and autonomy to grow both personally and professionally, and the opportunity to own large parts of the business and scale with the company.

Angle Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Angle Health is committed to working with and providing reasonable accommodations to applicants with physical and mental disabilities.

Why you should join Angle Health

At Angle Health, we're tackling the healthcare crisis at the point where our health system starts and stops: health insurance. By building a modern, technology-driven health plan, we are creating a customer-centric experience that gets our members the care they need when they need it. We're on a journey to making people healthier and we're starting with startups. If you want to be part of the future of healthcare, we'd love for you to join us.