Claims Processor, Advanced
About The Position
The Claims Processor, Advanced works on the Accumulations Team, which manages and maintains member accumulations by researching, auditing, updating, and posting data to ensure accurate deductible and out-of-pocket balances. The role monitors inventory, tracks aging, prioritizes audit requests, and processes member accumulation transfers between plans according to system guidelines. It also collaborates with business partners, assists with audits and remediation efforts, supports training, and serves as a subject matter expert for testing and documentation reviews. The position reports to the Claims Operations Supervisor. The organization describes a leadership model focused on developing leaders at all levels and creating opportunities for personal, professional, and financial growth. It seeks leaders who use creative and critical thinking, build and sustain high-performing teams, achieve results responsibly, and foster continuous learning. This is a hybrid role. Employees generally work in the office two days each week; employees who live more than 50 miles from an office location will work with their manager to determine in-office time based on business needs.
Requirements
- High school diploma or GED, or one year of additional relevant experience in lieu of a diploma.
- Five years of previous experience required.
- Broad knowledge of operational systems and practices within Claims Processing.
- Proficiency in front-end and back-end processing, including the ability to identify, analyze, and resolve errors.
- Demonstrated ability to process multiple claim types or specialties.
- Deep understanding of end-to-end claims processing fundamentals.
- Intermediate-advanced skills creating documents and files using Excel, Outlook, PowerPoint, and Word.
- Ability to work independently and in a team environment.
- Strong time-management and detailed research skills.
Responsibilities
- Research accumulations and update them accordingly.
- Independently process complex and high-risk claims across multiple products or specialties.
- Pull, format, and send reports to necessary teams.
- Review applications and recommend system edits or changes as needed.
- Complete special processing assignments and coordinate with other departments for resolution when needed.
- Consistently exceed performance metrics and quality standards.
- Manage time effectively, multitask, conduct detailed research, and meet deadlines with excellent quality.
- Serve as a subject matter resource for selected claim types and provide guidance to peers.
- Identify, analyze, and resolve system and processing errors with minimal escalation.
- Assist with training, documentation review, and workflow support, and act as backup to lead roles.
- Perform other duties as assigned.
- Monitor inventory, track aging, and prioritize audit requests.
- Process member accumulation transfers between plans according to system guidelines.
- Collaborate with business partners and assist with audits and remediation efforts.
- Support testing and documentation reviews as a subject matter expert.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
