Sr Claims Analyst - LHB

Health Care Service Corporation

1d•$18 - $34•Onsite

About The Position

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. Life & Disability - Sr Claims Analyst Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws; achieving results by effective use of all appropriate resources. 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.

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
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.
Strong math and decision-making skills.
Ability to work in a deadline driven, fast-paced environment.
Self-motivated with high learning agility.
Excellent verbal and written communication skills with a passion for helping others.
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.
Strong commitment to teamwork and 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

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

Responsibilities

Accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups.
Handle all claims and inquiries according to established plan documents, claim processing guidelines, and established total turnaround times.
Advise team members regarding claim processing procedures.
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.