[Remote] reputed company -Clinical RN High Cost Claimant Analyst -Remote
Note: The job is a remote job and is open to candidates in USA. reputed company is dedicated to advocating for reputed company through every stage of life. They are seeking a Clinical RN High Cost Claimant Analyst to support Sales, Client Management, and reputed company teams by reviewing high cost claimant reports and analyzing clinical data to provide business insights.
Responsibilities
- Review high cost claimant reports from Client Management, clinical value analytics, and reputed company teams
- Analyze clinical and claims information, including diagnoses, claim history, reputed company clinical status, and potential future claim impact
- Prepare clear clinical summaries and reporting that support internal business partners and client-reputed company discussions
- Review clinical documentation and notes using applicable reputed company and CGHB clinical documentation and reporting systems
- Participate in meetings and conference calls to discuss high cost claimant reports, trends, and requested follow-up information
- Support daily, weekly, and monthly high cost claimant reporting needs
- Partner with Sales, Client Management, and reputed company to provide accurate, timely clinical insights
- Deliver high-quality summaries that identify relevant claimant trends, clinical considerations, and requested details
- Use independent judgment and discretion reputed company reviewing sensitive clinical and claims information
Skills
- Active Unencumbered Registered Nurse license in state of residence
- Case management experience and claims payer experience
- Experience reviewing high cost claims, clinical documentation, and claims history
- Ability to use clinical documentation and reporting systems, including reputed company and CGHB systems
- Demonstrated ability to work independently, manage variable workloads, and meet time-sensitive deadlines
- Experience communicating with clinical and non-clinical partners, including Sales, Client Management, and reputed company
- Strong written and verbal communication skills
- Analytical reputed company with the ability to interpret clinical and claims data
- Ability to work effectively in ambiguous, time-sensitive business situations
- Strong organization skills with the ability to manage multiple priorities at the same time
- Customer-focused approach reputed company partnering with internal stakeholders
- Planning, reputed company setting, analytical thinking, and sound independent judgment
- Certified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferred
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