Senior Claims Analyst

Acrisure • San Diego, CA

2d • $33 - $35 • Onsite

About The Position

SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage. SBMA has a current need for a full-time Senior Claims Analyst. The Senior Claims Analyst is a critical member of SBMA’s Claims Department, responsible for overseeing the most complex claims adjudication tasks and ensuring operational excellence across all claims functions. This role provides advanced support, guidance, and informal mentorship to Claims Analyst I and II team members, acting as a subject matter expert (SME) for HealthPac and SBMA’s internal processes. The Senior Claims Analyst helps streamline workflows, improve accuracy and turnaround times, and support continuous improvement efforts across the department. This position plays a key role in resolving escalated issues, developing SOPs, and enhancing departmental efficiency.

Requirements

• High School Diploma or equivalent
• Minimum 4 years of experience in medical claims adjudication
• Minimum 3 years of HealthPac system use
• Demonstrated experience working with Reference Based Pricing (RBP), QPA, and complex claims scenarios
• Expert-level proficiency in HealthPac
• Strong understanding of medical billing, coding, and adjudication processes
• Proven ability to train, guide, and mentor peers
• Advanced Excel and reporting skills
• Exceptional attention to detail and organizational abilities
• Excellent verbal and written communication skills
• Ability to handle sensitive information with confidentiality
• Strong problem-solving skills and ability to think critically under pressure
• Able to work independently while coordinating with multiple departments
• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times

Nice To Haves

• 5+ years of medical claims experience, with increasing levels of responsibility
• Previous experience in a lead or trainer role within a claims department

Responsibilities

• Review and process complex or high-priority claims, including escalated or disputed claims.
• Provide quality assurance and auditing of Claims Analyst I and II work to ensure compliance with turnaround time (TAT), accuracy, and best practices.
• Serve as department liaison to IT or vendor support on claims system-related issues or enhancements.
• Lead training sessions and support the professional development of junior analysts.
• Assist the Claims Manager in updating and maintaining standard operating procedures (SOPs) and training documentation.
• Analyze claims trends, identify root causes of processing errors, and recommend workflow improvements.
• Coordinate with internal teams (Eligibility, Client Services, Accounting) to resolve cross-functional issues.
• Manage specialized tasks such as high-dollar claims review, provider dispute resolution, or out-of-network pricing strategies.
• Support and generate weekly, monthly, and ad hoc claims reporting.
• Maintain expert-level knowledge of HealthPac and payer requirements.
• Perform all duties of a Claims Analyst II when needed.

Benefits

• Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
• Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
• Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
• Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees