Claims Analyst

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

📋 Description

• Accurately evaluate and process claims related to medical, dental, vision, life, disability, or other associated categories for designated groups.

• Manage related correspondence and electronic inquiries effectively.

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

• Achieve established total turnaround times consistently.

• Investigate claims thoroughly and make decisions based on analytical, mathematical, and claims-examination criteria.

• Prioritize workload efficiently, managing and following up on multiple tasks.

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

• Adapt to improvements in processes, system platforms, and shifting priorities.

⛳️ Requirements

• High School diploma or equivalent GED.

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

• Proficient verbal and written communication skills.

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

• Capacity to apply common sense understanding to execute instructions provided in oral, written, or diagrammatic form.

• Flexible and open to ongoing process improvements.

• Ability to learn new/proprietary systems, adapt to different system platforms, and proficiently use MS Excel/Word.

• Familiarity with claims examination processes.

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

• Solid mathematical and decision-making abilities.

• Ability to work effectively in a deadline-driven, fast-paced environment.

• Self-motivated with a strong capacity for learning.

• Excellent verbal and written communication skills with a genuine passion for assisting others.

• Self-starter with robust time management skills to prioritize workload and manage multiple tasks.

• Capable of making decisions independently in the absence of specific directions with minimal supervision.

• Ability to adapt to change and adjust accordingly in a dynamic environment.

• Strong commitment to teamwork and the ability to contribute in a collaborative setting.

• Effective use of personal computers and associated software.

• Proficiency in Word, Excel, and Outlook.

• Preferred: 1 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: Familiarity with medical terminology.

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

• Preferred: Bachelor’s degree in a medical and/or business-related field.

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

• Preferred: Proficiency in Microsoft Access.

🏝️ Benefits

• Comprehensive 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.