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 Claim Unit, vendor personnel, Claims Team, and internal departments.

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

• Manage related correspondence and electronic inquiries for designated groups.

• Address claims and inquiries in accordance with plan documents, processing guidelines, and established turnaround times.

• Provide guidance to team members on claim processing protocols.

• Gather and evaluate information regarding life and disability claims.

• Make determinations on life and disability benefits based on policy provisions and applicable state and federal regulations.

• Calculate benefit payments and convey decisions on both new and ongoing claims.

• Deliver responsive and compassionate customer service.

• Complete tasks under general management supervision.

⛳️ Requirements

• High School diploma or GED equivalent required.

• At least 3 years of previous experience in medical claim processing.

• A minimum of three years of life and/or disability claim administration experience for the Life & Disability position.

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

• Exceptional verbal and written communication abilities.

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

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

• Open-minded and adaptable to ongoing process enhancements.

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

• Strong leadership, organizational, and interpersonal skills.

• Competent in managing complex situations and achieving resolutions.

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

• Proficient in adapting to different system platforms and effectively utilizing MS Excel and Word.

• Strong skills in investigation, analysis, organization, mathematics, decision-making, and attention to detail.

• Ability to function in a deadline-driven, fast-paced setting.

• Self-driven with high learning agility.

• Excellent time management skills for prioritizing workload and managing multiple tasks.

• Capable of making independent decisions or working with minimal supervision.

• Ability to adjust to changes and shift focus in a dynamic environment.

• Strong commitment to teamwork and collaborative efforts.

• Effective use of personal computers and relevant software.

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

• Familiarity with medical terminology preferred.

• Experience in Health Insurance/Third Party Administration preferred.

🏝️ Benefits

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

• 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.