Claims Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Efficiently adjudicate and process medical, dental, vision, life, disability, or other related claims for designated groups.

• Manage corresponding communications and electronic inquiries.

• Process claims in accordance with established plan documents and claim processing protocols.

• Adhere to defined turnaround times.

• Review claims and perform thorough investigations.

• Make analytical and claims-related decisions with minimal oversight.

• Prioritize tasks and manage a diverse workload while following up on numerous responsibilities.

• Collaborate effectively with team members, employees/members, providers, and clients.

• Adjust to process enhancements, system platforms, and shifting priorities.

⛳️ Requirements

• High School diploma or GED equivalent.

• Capability to work in a fast-paced, customer-focused, and production-oriented environment.

• Strong verbal and written communication skills.

• Ability to collaborate effectively with team members, employees/members, providers, and clients.

• Competence in using common sense to interpret and execute oral, written, or diagrammatic instructions.

• Willingness to be flexible and embrace ongoing process improvements.

• Aptitude for learning new/proprietary systems, adapting to various system platforms, and proficient use of MS Excel/Word.

• Understanding of claims examination processes.

• Excellent investigation, analytical, organizational skills, and attention to detail.

• Strong mathematical and decision-making abilities.

• Capacity to operate in a deadline-driven, fast-paced environment.

• Self-motivated with a strong ability to learn quickly.

• Exceptional verbal and written communication skills, coupled with a genuine passion for assisting others.

• Self-starter with effective time management skills to prioritize tasks and manage follow-ups on multiple responsibilities.

• Ability to make decisions in the absence of explicit directions with minimal supervision.

• Proficient at coping with change and adjusting accordingly in a dynamic setting.

• Strong commitment to teamwork and collaborative work.

• Proficient use of personal computers and relevant software.

• Familiarity with Word, Excel, and Outlook.

• One year of experience in health insurance (preferred).

• Experience with Self-Funded Insurance/Benefits and/or TPA (preferred).

• Knowledge of medical procedure and diagnosis coding (preferred).

• Understanding of medical terminology (preferred).

• Familiarity with Summary Plan Documents (SPDs), insurance booklets, or other benefit descriptive materials (preferred).

• Four-year college degree in a medical and/or business field (preferred).

• Knowledge of life and/or disability claims (preferred).

• Proficiency in Microsoft Access (preferred).

🏝️ Benefits

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Additional incentives.

• Annual incentive bonus plan subject to the terms and conditions of the plan.