Sr Claims Analyst - LHB

About the role

This position includes a variety of claim administrative and technical tasks that support a Claim Unit and/or vendor staff, as well as the Claims Team and serves as a liaison for any internal departments. The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times. The role also involves advising team members regarding claim processing procedures.

Responsibilities

• Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws.
• Calculate benefit payments and communicate claim decisions on new and continuing claims.
• Provide responsive and caring customer service.
• Perform all tasks completed under general supervision of management, including those of a Claim Analyst.
• Demonstrate critical thinking to carry out instructions furnished in oral, written, or diagram form.
• Analyze and interpret documents and Summary Plan Descriptions (SPDs).
• Adapt to various system platforms and effectively use MS Excel and Word.
• Handle complex situations and reach resolution.

Requirements

• High School diploma or GED equivalent.
• 3 years prior medical claim processing experience.
• Ability to work in a fast-paced, customer-centric, and production-driven environment.
• Excellent verbal and written communication skills.
• Ability to work effectively with employees, members, providers, clients, and differing levels of co-workers, including Client Managers and all levels of staff.
• Demonstrated critical thinking and flexibility; open to continued process improvements.
• Self-directed individual who works well with minimal supervision.
• Good leadership, organizational, and interpersonal skills.
• Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs).
• Proficiency in MS Excel, Word, and Outlook; Access preferred.

Preferred Qualifications

• Health Insurance/Third Party Administrator experience.
• Minimum three years of life and/or disability claim administration experience, including solid investigation, analytical, and organizational skills with attention to detail.
• Strong math and decision-making skills.
• Four-year college degree in medical and/or business field (a plus).
• Understanding of medical terminology.
• High learning agility and self-motivation.
• Strong time management skills to prioritize workload, manage, and follow up on numerous tasks.
• Capable of making decisions in the absence of specific directions, independently or with minimal supervision.
• Ability to effectively cope with change and shift gears in a dynamic environment.
• Strong commitment to teamwork and ability to work in a collaborative environment.

Benefits

• Health and wellness benefits.
• 401(k) savings plan and pension plan.
• Minimum of 15 days of paid time off.
• Paid parental leave.
• Disability insurance and supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Annual incentive bonus plan (subject to terms and conditions).

Pay

Min to Max Range: $18.07 - $33.92 per hour. Exact compensation may vary based on skills, experience, and location.