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, and the Claims Team.

• Act as a communication bridge for internal departments.

• Precisely evaluate and process claims for medical, dental, vision, and other associated services.

• Manage correspondence and electronic inquiries for designated groups.

• Process claims and inquiries in accordance with plan documents, claim processing protocols, and expected turnaround times.

• Provide guidance to team members on claim processing techniques.

• Gather and analyze claim data for life and disability benefit decisions.

• Compute benefit payments accurately.

• Relay decisions on new and ongoing claims.

• Deliver responsive and compassionate customer service.

• Complete tasks under the general oversight of management.

⛳️ Requirements

• High School diploma or GED equivalent is required.

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

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

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

• Exceptional verbal and written communication abilities.

• Proficiency in working effectively with employees/members, providers, clients, and various levels of colleagues.

• Proven critical thinking skills.

• Open-mindedness and flexibility towards ongoing process enhancements.

• Self-motivated individual who performs well with minimal supervision.

• Strong leadership, organizational, and interpersonal capabilities.

• Competence in managing complex situations and achieving resolutions.

• Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs).

• Adaptability to various system platforms.

• Proficient use of MS Excel and Word.

• Strong mathematical and decision-making abilities.

• Excellent time management skills.

• Capacity to work independently or with limited oversight.

• Ability to collaborate effectively within a team setting.

• Proficient use of personal computers and related software.

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

• Familiarity with medical terminology is advantageous.

• A four-year college degree in a medical or business-related field is a plus, though not mandatory.

🏝️ 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.

• Other incentives.

• Annual incentive bonus plan.