Senior Claims Analyst

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CareAllies

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2016

🏥 Healthcare

🤝 B2B

Healthcare • B2B

CareAllies is a healthcare services company that helps physician organizations and health plans succeed in value-based care. It provides business advisory, care coordination, practice and network management, and data/technology support to independent physician associations (IPAs), ACOs, clinically integrated networks and other provider groups. CareAllies focuses on operationalizing value-based contracts (from pay-for-performance to full risk), reducing administrative burden for clinicians, improving patient outcomes, and supporting growth and retention for providers and health plans across commercial, Medicare, and Medicare Advantage arrangements.

📋 Description

• Perform claim administrative and technical tasks supporting a Claim Unit, vendor staff, Claims Team, and internal departments • Serve as a liaison for internal departments • Accurately adjudicate and process medical, dental, vision, and related claims for assigned groups • Handle claim correspondence and electronic inquiries according to plan documents, processing guidelines, and turnaround times • Advise team members regarding claim processing procedures • Secure and analyze life and disability claim information • Make life and disability benefit determinations in accordance with policy provisions and applicable state and federal laws • Calculate benefit payments and communicate decisions on new and continuing claims • Provide responsive and caring customer service • Complete tasks under general management supervision

🎯 Requirements

• High School diploma or GED equivalent • 3 years prior medical claim processing experience • Minimum three years of life and/or disability claim administration experience, or equivalent combination of relevant 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, Client Managers, and staff at differing levels • Demonstrated critical thinking and ability to follow oral, written, or diagrammed instructions • Flexibility and openness to continued process improvements • Self-directed and able to work with minimal supervision • Good leadership, organizational, interpersonal, math, decision-making, and time-management skills • Ability to handle complex situations and reach resolution • Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) • Ability to adapt to various system platforms • Effective use of personal computers and related software • Proficiency with Microsoft Word, Excel, and Outlook; Access preferred • Ability to work in a deadline-driven, fast-paced environment • High learning agility and ability to prioritize, manage, and follow up on numerous tasks • Ability to make decisions independently or with minimal supervision • Ability to cope with change and shift gears in a dynamic environment • Commitment to teamwork and ability to work collaboratively • Understanding of medical terminology preferred • Health insurance/Third Party Administrator experience preferred • Four-year college degree in a medical and/or business field is a plus

🏖️ Benefits

• Curated development plans that foster growth and promote rewarding, fulfilling careers • Health and wellness benefits • 401(k) savings plan • Pension plan • Minimum of 15 days’ paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan