Claims Analyst

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

📋 Description

• Evaluate claims related to health insurance, life insurance, and disability.

• Investigate claims and perform thorough examinations.

• Utilize analytical, organizational, mathematical, and decision-making abilities in claims evaluations.

• Manage and prioritize a diverse workload while following up on multiple tasks.

• Operate independently with minimal supervision, making decisions without explicit guidance.

• Adjust to changes in processes and adapt to evolving environments.

• Work collaboratively with team members, employees/members, providers, and clients.

• Utilize proprietary systems alongside Microsoft Word, Excel, Outlook, and other related software.

⛳️ Requirements

• A high school diploma or GED equivalent is required.

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

• Strong verbal and written communication skills are essential.

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

• Competence in following oral, written, or diagrammatic instructions using common sense understanding.

• Willingness to embrace ongoing process improvements.

• Aptitude for learning new or proprietary systems, adapting to various platforms, and efficiently using MS Excel/Word.

• Understanding of claims examination processes.

• Strong investigation, analytical, and organizational skills are necessary.

• Attention to detail is crucial.

• Proficient mathematical and decision-making abilities are required.

• Ability to work under deadlines in a dynamic, fast-paced setting.

• High learning agility and self-motivation are essential traits.

• Excellent verbal and written communication skills are mandatory.

• Strong time management skills to effectively prioritize and follow up on a multitude of tasks.

• Ability to make informed decisions with limited supervision.

• Capacity to adapt to changes and shift focus in a dynamic environment.

• Commitment to teamwork and collaborative efforts.

• Proficient use of personal computers and related software is necessary.

• Proficiency in Word, Excel, and Outlook is expected.

• Preferred: A minimum of 1 year of experience in Health Insurance.

• Preferred: Experience with Self-Funded Insurance/Benefits and/or TPA.

• Preferred: Familiarity with medical procedure and diagnosis coding.

• Preferred: Knowledge of medical terminology.

• Preferred: Understanding of Summary Plan Documents (SPDs)/Insurance Booklets or other descriptive benefits materials.

• Preferred: A four-year college degree in a medical or business-related field.

• Preferred: Knowledge of Life and/or Disability claims.

• Preferred: Proficiency in Microsoft Access.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Participation in a 401(k) savings plan.

• Access to a pension plan.

• Generous paid time off policy.

• Paid parental leave.

• Disability insurance coverage.

• Supplemental life insurance options.

• Employee assistance program available.

• Paid holidays.

• Tuition reimbursement support.

• Additional incentives offered.

• Eligibility for an annual incentive bonus plan.