Claims Analyst analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. Being a Claims Analyst maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims. Additionally, Claims Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. The Claims Analyst gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Analyst typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
POSITION SUMMARY
This position is responsible for accurate reporting and filing of claims to the respective Carrier, in addition to handling complex claims scenarios along with resolution of claims disputes. The Claims Analyst has a diverse subject matter expertise and functions as a high-level professional that provides guidance to the Customers, Producers and Sr. Leadership on more complex claim’s issues. The Claims Analyst is responsible for monitoring the assigned inventory of claims, answering phone calls, consulting on claims related issues. Duties also include: handling customer service calls as needed, claim reviews on an as needed basis, development and implementation of a formal claims management program.
Responsible for the completion of all compliance training related to the position.
Must understand all applicable laws and regulations that apply to the position and comply with the requirements.
NON-ESSENTIAL FUNCTIONS
Performs all other duties as assigned.
TRAVEL REQUIREMENTS
Ability to travel as needed for meetings, projects, seminars, etc.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.
While performing the duties of this job, the employee is required to sit, stand and walk; use hands and fingers to operate keyboard and other office equipment; reach with hands and arms; and talk or hear. The employee is occasionally required to stoop or kneel. The employee may occasionally lift and/or move up to 10 pounds.
PROGRAMS / EQUIPMENT
MS Office, Adobe Acrobat, Applied EPIC, PC’s, fax, phone and standard office equipment.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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