Claims Analyst - LHB

Health Care Service Corporation

5d•$15 - $28•Onsite

About The Position

The 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.

Requirements

High School diploma or GED equivalent
Ability to work in a fast-paced, customer centric and production driven environment
Effective verbal and written communication skills
Ability to work effectively with team members, employees/members, providers, and clients
Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
Flexible; open to continued process improvement
Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word
An understanding of claims examining
Solid investigation, analytical and organizational skills, and attention to detail.
Strong math and decision-making skills.
Ability to work in a deadline driven, fast-paced environment.
Self-motivated with high learning agility.
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 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.

Nice To Haves

1 year Health Insurance experience
Self-Funded Insurance/Benefits and/or TPA experience
Knowledge of medical procedure and diagnosis coding
Knowledge of medical terminology
Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools
Four-year college degree in medical and/or business field.
Life and/or Disability claim knowledge.
Proficiency in working with Microsoft Access.

Responsibilities

Accurate adjudication and processing of medical, dental, vision, or other related claims.
Handling related correspondence and/or electronic inquiries for assigned groups.
Ensuring all claims and inquiries are handled according to established plan documents, claim processing guidelines, and established total turnaround times.
Investigating claims.
Analyzing claims.
Organizing claims information.
Prioritizing workload.
Managing and following up on numerous tasks.
Making decisions in the absence of specific directions with minimal supervision.
Coping with change and shifting gears accordingly in a dynamic environment.
Displaying a strong commitment to teamwork and working in a collaborative environment.
Effectively using personal computers and related software, including Word, Excel, and Outlook.