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 liaison for various internal departments.

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

• Manage related correspondence and electronic inquiries for designated groups.

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

• Provide guidance to team members on claim processing procedures.

• Obtain and analyze claim information to determine life and disability benefits in line with policy provisions and relevant state and federal regulations.

• Calculate benefit payments.

• 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.

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

• Capable of working in a fast-paced, customer-focused, and production-driven environment.

• Exceptional verbal and written communication abilities.

• Proficient in collaborating effectively with employees/members, providers, clients, and various levels of co-workers, including Client Managers and all staff levels.

• Demonstrated critical thinking skills to execute instructions provided in oral, written, or diagram form.

• Adaptable and open to ongoing process improvements.

• Self-directed individual with the ability to work well with minimal supervision.

• Strong leadership, organizational, and interpersonal skills.

• Capable of effectively managing complex situations and achieving resolutions.

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

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

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

• Strong investigative, analytical, and organizational skills with a keen attention to detail.

• Excellent mathematical and decision-making abilities.

• Must be capable of working in a deadline-driven, fast-paced environment.

• Self-motivated with high learning agility.

• Must be a self-starter with strong time management skills to prioritize workload and manage numerous tasks effectively.

• Able to make decisions in the absence of specific directions, either independently or with minimal supervision.

• Capable of effectively coping with change and adjusting accordingly in a dynamic environment.

• Must exhibit a strong commitment to teamwork and possess the ability to work in a collaborative setting.

• Effective in using personal computers and related software.

• Proficient in working with Word, Excel, and Outlook; Access knowledge preferred.

• 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 a plus.

🏝️ 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.