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 staff, Claims Team, and internal departments.

• Precisely adjudicate and process medical, dental, vision, and other related claims.

• Manage related correspondence and electronic inquiries for designated groups.

• Process claims and inquiries in line with plan documents, claim processing guidelines, and established turnaround times.

• Provide guidance to team members concerning claim processing procedures.

• Gather and analyze claim information to make determinations on life and disability benefits according to policy provisions and applicable state and federal regulations.

• Calculate benefit payments accurately.

• Communicate decisions regarding new and ongoing claims.

• Deliver responsive and compassionate customer service.

• Complete tasks under the general supervision of management.

⛳️ Requirements

• High School diploma or GED equivalent.

• Three years of prior experience in medical claim processing.

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

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

• Excellent verbal and written communication skills.

• Capability to work effectively with employees/members, providers, clients, and various levels of co-workers.

• Proven critical thinking skills.

• Willingness to embrace ongoing process improvements.

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

• Strong leadership, organizational, and interpersonal skills.

• Ability to manage complex situations and achieve resolutions.

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

• Adaptability to various system platforms.

• Effective use of MS Excel and Word.

• Strong mathematical and decision-making abilities.

• Excellent time management skills.

• Capacity to work independently or with limited supervision.

• Ability to adapt to changes in a dynamic environment.

• Strong commitment to teamwork with an ability to collaborate effectively.

• Proficient use of personal computers and related software.

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

• Familiarity with medical terminology is preferred.

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