Intake Care Associate AnalystNew!

• Review and process preauthorization requests for medical services, procedures and treatments.
• Assess medical necessity using clinical guidelines, policy criteria and regulatory requirements.
• Collaborate with clinical teams to confirm appropriate level of care and service utilization.
• Identify high-risk or high-cost cases early and route them for care coordination.
• Conduct detailed reviews of medical claims for accuracy, coding integrity and benefit alignment.
• Identify billing discrepancies, overutilization and cost-saving opportunities.
• Support appeals, reconsiderations and audit activities.
• Analyse trends in high-cost claims and recommend process improvements.
• Lead or support negotiations on out-of-network claims, high-cost procedures and single case assignments.
• Document and track savings outcomes, including financial and operational impact.

Qualifications & Experience:

• Degree or diploma, with additional education in healthcare, business or a related field preferred.
• Knowledge of medical claims adjudication, prior authorization, medical necessity review and utilization management.
• Ability to review clinical documentation and apply established coverage criteria.
• Coding certification such as CPC or CCS is an added advantage.

Skills & Competencies:

• Excellent written and oral communication with a good telephone manner.
• High level of accuracy and attention to detail.
• Ability to multi-task and adapt in a 24/7 shift environment.
• Problem solving and sound decision making.
• Ability to interpret data and identify trends.
• Strong teamwork across clinical, provider and operations teams.