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 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.

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
• All tasks completed under general supervision of management

Required Qualifications

• 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 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

Preferred Qualifications

• Health Insurance/Third Party Administrator Experience
• Four-year college degree in medical and/or business field a plus
• Understanding of medical terminology
• Proficiency in Access preferred

Life & Disability - Senior Claims Analyst Minimum Requirements

• 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
• Capable of making decisions in the absence of specific directions, independently or with minimal supervision
• Ability to effectively cope with change and shift gears accordingly in a dynamic environment
• Must display a strong commitment to teamwork and have the ability to work in a collaborative environment
• Effective in the use of personal computers and related software
• Proficiency in working with Word, Excel and Outlook

Pay

$18.07 - $33.92 per hour. Exact compensation may vary based on skills, experience, and location. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.