Sr Claims Analyst - LHB

Job Summary

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. In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including 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. Also advise team members regarding claim processing procedures.

About the Role

CareAllies empowers employees with curated development plans that foster growth and promote rewarding, fulfilling careers. This position supports the Claims Team and serves as a liaison for internal departments, handling medical, dental, vision, or other related claims.

Responsibilities

• Accurately adjudicate and process medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups.
• Adhere to established plan documents, claim processing guidelines, and total turnaround times.
• Advise team members regarding claim processing procedures.
• 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.

Requirements

• High School diploma or GED equivalent
• 3 years prior medical claim processing experience
• Ability to work in a fast-paced, customer centric & 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, to carry out instructions furnished in oral, written or diagram form
• Flexible; open to continued process improvements
• Self-directed individual who works well with minimal supervision
• Good leadership, organizational and interpersonal skills
• Ability to effectively handle with complex situations and reach resolution
• Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
• Ability to adapt to various system platforms, and to effectively use MS Excel/Word

Qualifications

• Minimum three-years life and/or disability claim administration experience: solid investigation, analytical and organizational skills along with attention to detail; or the equivalent combination of relevant experience.
• Must have strong math and decision-making skills.
• Must be able to work in a deadline driven, fast-paced environment.
• Self-motivated with high learning agility.
• Must have excellent verbal and written communication skills with a passion for helping others.
• Must be a self-starter with strong time management skills to prioritize workload, manage and follow-up on numerous tasks.
• Four-year college degree in medical and/or business field a plus.
• Understanding of medical terminology.

Skills

• Strong math and decision-making skills
• Attention to detail
• Effective communication skills
• Ability to work in a deadline driven, fast-paced environment
• Self-motivated with high learning agility
• Excellent verbal and written communication skills
• Strong time management skills
• Ability to prioritize workload and manage multiple tasks
• Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
• Ability to adapt to various system platforms and use MS Excel/Word
• Understanding of medical terminology

Benefits

All tasks completed under general supervision of management. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min To Max Range $18.07 - $33.92 Exact compensation may vary based on skills, experience, and location.

Pay

The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min To Max Range $18.07 - $33.92 Exact compensation may vary based on skills, experience, and location.

Schedule

The schedule for this role is not specified.

Qualifications

Minimum requirements include a High School diploma or GED equivalent, 3 years prior medical claim processing experience, and strong math and decision-making skills. Preferred qualifications include a four-year college degree in medical and/or business field, understanding of medical terminology, and experience in health insurance/Third Party Administrator.

Skills

Skills required include strong math and decision-making skills, attention to detail, effective communication skills, ability to work in a deadline driven, fast-paced environment, self-motivation, high learning agility, excellent verbal and written communication skills, strong time management skills, ability to analyze and interpret documents and Summary Plan Descriptions (SPDs), ability to adapt to various system platforms, and understanding of medical terminology.

Benefits

Includes a robust total rewards package for full-time employees, which may include health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, and other incentives.