Senior Claims Analyst

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

📋 Description

• Execute administrative and technical tasks related to claims, providing support to a Claim Unit, vendor personnel, and the Claims Team.

• Act as a liaison for internal departments.

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

• Manage related correspondence and electronic inquiries for designated groups.

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

• Guide team members on procedures for claim processing.

• Gather and evaluate claim information to determine life and disability benefits.

• Implement policy provisions alongside applicable state and federal regulations.

• Calculate benefit payments accurately.

• Communicate decisions regarding new and ongoing claims.

• Deliver responsive and compassionate customer service.

• Complete responsibilities under the general supervision of management.

⛳️ Requirements

• High School diploma or GED equivalent.

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

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

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

• Excellent verbal and written communication abilities.

• Proficient in working effectively with employees/members, providers, clients, and various levels of co-workers.

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

• Open-minded and adaptable to 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.

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

• Adaptable to various system platforms and proficient in using MS Excel/Word.

• Strong mathematical and decision-making capabilities.

• Highly motivated with a quick learning ability.

• Effective time management skills to prioritize workload and manage multiple tasks.

• Competent in making decisions independently or with minimal oversight.

• Ability to adapt to change and transition smoothly in a dynamic environment.

• Strong commitment to teamwork and collaboration.

• Proficient in the use of personal computers and related software.

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

• Familiarity with medical terminology is 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.