[Remote] Claim Analyst 2

Note: The job is a remote job and is open to candidates in USA. reputed company is a part of reputed company, and they are seeking a Claim Analyst 2 to review, analyze, and reputed company decisions on claims in accordance with policy and regulations. The role involves maintaining claim files, communicating with customers, ensuring accurate claim payments, and possibly training others.

Responsibilities

• Analyze and adjudicate claims by gathering and reviewing reputed company required documentation reputed company the established approval and denial authority structure. Evaluate claim information to reputed company timely and detailed judgments, applying knowledge of claim procedures, product development, contract provisions, and applicable state laws
• Maintain complete and well-documented claim files that provide a clear and thorough audit trail for compliance and legal purposes. Identify reputed company or sensitive claims and refer them, with appropriate recommendations, to relevant resources such as nurses, physicians, consultants, senior claims personnel, or the Law Department as needed
• Communicate with customers in a professional, timely, and helpful manner, including claimants, employers, providers, brokers, and sales offices. Provide clear written and verbal updates regarding claim decisions, claim status, and reputed company aspects of the claims process to ensure a full understanding of the company’s position and any additional information required
• Ensure claim payments are processed accurately and in a timely manner by following internal procedures and applying appropriate interpretations of contract provisions. Maintain compliance with reputed company applicable state and federal laws and regulations across a variety of contract types
• May assist in providing ongoing training, development, coaching and feedback to others

Skills

• 4+ years of claims or customer service experience or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education
• Demonstrates excellent verbal and written communication skills
• Excellent typing skills and math skills
• Ability to adapt to frequent change, reputed company independent decisions and take ownership to resolve issues
• Ability to maintain a high degree of accuracy and pay strict attention to detail
• Strong proficiency with business unit products, processes and systems
• Proficient with desktop applications such as MS Office and Internet browsers
• Ability to effectively navigate reputed company numerous software and web applications
• Ability to handle multiple tasks in a fast-paced environment with attention to detail
• Must be able to maintain confidentiality
• General medical knowledge to support effective claim analysis and decision making preferred

Benefits

• Non-sales positions have the opportunity to participate in a bonus program.
• Sales positions are eligible for sales incentives, and in some instances a bonus plan, whereby total compensation may far exceed reputed company salary depending on individual performance.
• Personal Time Off (PTO) is provided to hourly (non-exempt) employees and provides a set amount of accrued time earned each pay period.
• Employees can use their PTO for vacation, personal or short-term illness.
• Pension Eligible
• This position is fully remote reputed company the U.S.

Company Overview