[Hiring] Sr 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.
• Ensure 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.
• Calculate benefit payments and communicate claim decisions on new and continuing claims.
• Provide responsive and caring customer service.

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 skills.
• 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 to effectively use MS Excel/Word.

Requirements

• Minimum three years life and/or disability claim administration experience.
• Strong investigation, analytical, and organizational skills along with attention to detail.
• Strong math and decision-making skills.
• Self-motivated with high learning agility.
• Excellent verbal and written communication skills with a passion for helping others.
• Strong time management skills to prioritize workload and manage 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, with proficiency in Word, Excel, and Outlook; Access preferred.

Preferred Job Qualifications

• Four-year college degree in medical and/or business field a plus.
• Understanding of medical terminology.

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.

Min to Max Range: $18.07 - $33.92. Exact compensation may vary based on skills, experience, and location.