[Hiring] Senior Claims Analyst @Health Care Service Corporation

Role Description

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.

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

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.

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 effectively use MS Excel/Word.

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.
• 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, Access preferred.

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.

Pay Transparency Statement

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.

Base Pay Range

$18.07 - $33.92. Exact compensation may vary based on skills, experience, and location.

Dearborn Group Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.