Claims Analyst II Regular Non-Exempt

This role involves analyzing and adjudicating claims and adjustments submitted in CMS-1500 and UB-04 formats, applying payment rules to determine appropriate processing, denial, or requests for additional information. The position requires reviewing original claims, adjustments, and reimbursements from various providers, including those in Puerto Rico, the United States, and international locations. The analyst must ensure financial accuracy, comply with company policies and federal regulations, and report any potential fraud or system deficiencies.