Medical Services Clinician Senior Analyst
- San Antonio, TX
Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions - underpinned by the world's largest delivery network - Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 469,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at www.accenture.com.
People in our Client Delivery & Operations career track drive delivery and capability excellence through the design, development and/or delivery of a solution, service, capability or offering. They grow into delivery-focused roles, and can progress within their current role, laterally or upward.
Medical Services Clinician Senior Analyst are part of the Expert Resource Team supporting Short term and or Long Term Disability Claims Teams supporting a large Group Insurance Business contract. The Medical Services Clinician Senior Analyst will collaborate with healthcare providers members to optimize member benefits.
- Adhere to medical policy and provide medically appropriate, high quality, cost effective service.
- Assess medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards.
- Pre-review screening under the guidance of US licensed health professionals.
- Review and assessment of primarily complex illness and injury claims
- Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for pre certification and or prior authorization.
- Verify benefits and or eligibility information.
- Check benefits for facility based treatment.
- Identify restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities.
- Complete review of pended claims utilizing Client screening tools post service for Medical Necessity or Contractual Reviews and submit recommendations to client for determination
- Current licensed Registered Nurse
- Minimum of 2 years of acute care experience
- Insurance industry experience
- Experience with Long Term Disability and/ or Short Term Disability products claims
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture.
Accenture is an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.
Equal Employment Opportunity: All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.
Accenture is committed to providing veteran employment opportunities to our service men and women.
Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.
Back to top