Claims Analyst (NSA/OON)

Insight Global’s client is seeking a detail-oriented Claims Analyst to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This individual will join a high-volume medical billing and revenue cycle team, focusing on insurance claim resolution, denials, AR follow-up, and collections, with a primary focus on out-of-network claims, including those governed by the No Surprises Act (NSA).

This person will be responsible for working outstanding insurance claims, troubleshooting denials, reviewing EOBs, following up with payers, and helping resolve aged receivables across out-of-network claims. The ideal candidate has strong medical collections experience, understands how to read and interpret EOBs, and can confidently work claims from identification through resolution, particularly within OON and NSA-related workflows.

Day-to-Day Responsibilities
-Work a blend of AR follow-up, denials management, and medical collections based on daily claim volume, aging, and dollar amount.
-Review, interpret, and troubleshoot EOBs to identify claim issues, underpayments, denials, missing documentation, coding-related concerns, and payer-specific requirements.
-Follow up with insurance carriers through payer portals and phone calls to resolve outstanding claims and expedite payment.
-Primarily manage out-of-network claims, including claims impacted by No Surprises Act timelines, regulations, and payer requirements.
-Prioritize aged receivables and high-dollar accounts while maintaining accurate documentation and claim notes.
-Review denials related to medical records requests, EDI rejections, coding issues, and payer processing rules.
-Partner with internal team members and trainers to ensure claims are worked accurately and consistently within department standards.
-Maintain patient and company confidentiality while ensuring all documentation is clear, accurate, and up to date.

Compensation:
$25 to $27 per hour.

Benefits:
-Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance
-401k and Profit sharing
-Paid Time Off
-Contribution to Health Benefits
-Company Discounts on Products & Services

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

-2+ years of medical billing, medical collections, AR follow-up, or denials experience.
-Experience working with out-of-network medical claims
-Strong ability to read and interpret EOBs; candidates should be comfortable walking through out-of-network reimbursement scenarios.
-Working knowledge of insurance claim processing, payer follow-up, claim denials, adjustments, refunds, and outstanding AR.
-Familiarity with No Surprises Act (NSA) workflows, timelines, or payer requirements.
-Familiarity with CPT codes, ICD codes, medical terminology, and common billing forms such as CMS-1500/HCFA and UB-04.
-Ability to work a high-volume claims queue while balancing speed, accuracy, and quality of documentation.
-Strong communication skills for payer follow-up, internal collaboration, and documentation.
-Adaptable, team-oriented mindset with the ability to follow established processes and build on existing training.

-Exposure to advanced NSA workflows.
-Experience supporting surgical, specialty, or high-volume healthcare billing environments.
-Experience with payer portals and EDI claim rejection workflows.
-Familiarity with TriZetto or similar clearinghouse systems.
-Experience working claims for major commercial payers such as Horizon, Aetna, Cigna, or similar carriers.

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.