Senior Claims Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $18 - $33 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 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 other related claims • Handle related correspondence and electronic inquiries for assigned groups • Process claims and inquiries according to plan documents, claim processing guidelines and turnaround times • Advise team members regarding claim processing procedures • Secure and analyze claim information to make life and disability benefit determinations • Apply 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 • Complete tasks under general supervision of management

🎯 Requirements

• High School diploma or GED equivalent • 3 years prior medical claim processing experience • Minimum three-years life and/or disability claim administration experience, or equivalent combination of relevant experience • Ability to work in a fast-paced, customer centric and production driven environment • Excellent verbal and written communication skills • Ability to work effectively with employees/members, providers, clients and differing levels of co-workers • Demonstrated critical thinking • Flexibility and openness to continued process improvements • Self-directed individual who works well with minimal supervision • Good leadership, organizational and interpersonal 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 MS Excel and Word • Strong math and decision-making skills • Self-motivated with high learning agility • Strong time management skills to prioritize workload, manage and follow up on numerous tasks • Ability to make decisions independently or with minimal supervision • Ability to cope with change in a dynamic environment • Strong commitment to teamwork and collaborative work • Effective use of personal computers and related software • Proficiency in Word, Excel and Outlook; Access preferred • Understanding of medical terminology preferred • Four-year college degree in medical and/or business field is a plus (preferred)

🏖️ 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 • Annual incentive bonus plan