Senior Claims Analyst

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

📋 Description

• Execute administrative and technical tasks related to claims, supporting a Claims Unit, vendor personnel, Claims Team, and internal departments.

• Act as a point of contact for internal departments.

• Precisely adjudicate and process medical, dental, vision, and associated claims for designated groups.

• Manage claim correspondence and electronic inquiries in accordance with plan documents, processing guidelines, and turnaround requirements.

• Provide guidance to team members concerning claim processing protocols.

• Collect and evaluate life and disability claim information.

• Determine life and disability benefits in alignment with policy provisions and relevant state and federal regulations.

• Compute benefit payments and relay decisions regarding new and ongoing claims.

• Deliver prompt and compassionate customer service.

• Accomplish tasks under general management oversight.

⛳️ Requirements

• High School diploma or GED equivalent.

• A minimum of 3 years of prior experience in medical claim processing.

• At least three years of life and/or disability claim administration experience, or a comparable combination of relevant experience.

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

• Strong verbal and written communication abilities.

• Proficiency in collaborating effectively with employees/members, providers, clients, Client Managers, and personnel across various levels.

• Proven critical thinking skills and the capacity to follow oral, written, or diagrammatic instructions.

• Willingness to embrace ongoing process improvements.

• Self-motivated and capable of working with minimal supervision.

• Strong leadership, organizational, interpersonal, mathematical, decision-making, and time-management skills.

• Ability to navigate complex situations and arrive at resolutions.

• Competence in analyzing and interpreting documents and Summary Plan Descriptions (SPDs).

• Adaptability to various system platforms.

• Effective utilization of personal computers and related software.

• Proficiency in Microsoft Word, Excel, and Outlook; Access knowledge preferred.

• Capacity to work in a deadline-driven, fast-paced setting.

• High learning agility with the ability to prioritize, manage, and follow up on multiple tasks.

• Ability to make independent decisions or operate with minimal supervision.

• Capability to adapt to change and shift focus in a dynamic environment.

• Strong commitment to teamwork and the ability to collaborate effectively.

• Familiarity with medical terminology is preferred.

• Experience in health insurance/Third Party Administration is preferred.

• A four-year college degree in a medical and/or business field is advantageous.

🏝️ Benefits

• Tailored development plans that encourage growth and support rewarding, fulfilling careers.

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Minimum of 15 days of paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Additional incentives.

• Annual incentive bonus program.