Claims Analyst 1

at Public Consulting Group in Augusta, Maine, United States

Job Description


About Public Consulting Group

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.-all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit .


· Analyzes the development of claims assigned at each level of the adjudication process.

· Outlines the case strategy and develop a Theory of the Case for each individual claim.

· Writes case summaries to be sent with applications.

· Monitors and gives direction to Claims Developer regarding specific tasks on claims.

· Provides monthly reporting statistics.

· Ensures adherence to claim timeliness and accuracy performance standards.

· Prepares for and participate in various meetings, including status reports, process improvement meetings and meetings related to collection of required data.

· Assists with quality control projects, including case reviews to ensure the integrity of claim methodology and eligibility determinations.

· Assists with preparation of other written reports and materials for clients.


+ Ability to evaluate, coordinate and perform a complex set of planning, development and administrative tasks.

+ Ability to build and maintain working relationships with federal, state and county agency staff.

+ Strong Microsoft application skills.

+ Ability to work with a large volume of claims and effectively prioritize the workload.

+ Excellent organizational, oral presentation and written communication skills.

+ Ability to work both in a team situation and autonomously.

+ Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid), and/or cost accounting are highly advantageous.

+ Knowledge and understanding of appropriate laws and regulations and applicable government agencies

Required Experience:

+ 2+ years of Medical Claims experience

+ Possesses a background as an insurance biller in a doctor’s office setting.

+ Knowledge in billing insurance healthcare claims to private/commercial and Medicaid insurance companies.

+ Working knowledge of health care procedural coding, ICD diagnosis codes, modifiers etc.

+ Able to interpret insurance claim rejections and denials.

+ Can perform data entry.

+ Self-motivated and able to work independently or as a group.

+ Willing to learn new information

Preferred Experience:

+ Proficient in troubleshooting and resolving customer support issues related to insurance billing.

+ Understands EOBs.

+ Able to work in a fast paced, high-volume environment.

+ A working knowledge of ANSI X12 Health Care transactions and standards.

+ A working knowledge of specialty care such as OT/PT/SLP


High School Diploma or equivalent required. A Bachelor’s Degree is preferred

This position is a remote, work from home position. PCG is a remote-friendly organization and is committed to creating a culture where remote work remains a vital part of the company’s success. To be successful in a remote work role at PCG, you must:

+ be available during your set working hours.

+ have a safe, private, and distraction-free environment in which to complete your work, and

+ be able to give your full attention to the completion of your PCG job duties.

Some travel to the office or elsewhere may be required for team meetings, client meetings, etc.

We are accepting applications on an ongoing basis until filled.


\#LI- Remote


Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $47,000-$52,000 and a potential discretionary bonus of up to 10 %. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employmentregarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programsare based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.


Job Locations US

Posted Date 1 week ago (6/20/2024 5:20 PM)

Job ID 2024-10437

\# of Openings 1

Category Case Management/Care Coordination

Type Regular Full-Time

Practice Area Human Services

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

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Job Posting: JC261665816

Posted On: Jun 22, 2024

Updated On: Jun 30, 2024

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