- Professional
- Office in Oakbrook Terrace
Position Overview:
The Claims Analyst is responsible for providing assistance to the Claims Manager while ensuring that claims are properly adjudicated in accordance with our Policy and the underlying Plan/Group Documents.
This position will report to the Claims Manager.
Essential Elements
- Review, analyze, manage, and adjudicate claims on the Stop Loss and Excess of Loss book of business to determine action to be taken.
- Research and resolve claim issues by identifying and analyzing problems and/or risks, and assembling the documentation needed to support the recommendation to resolve the problem.
- Maintain applicable logs, files, and company turnaround time standards.
- Maintain knowledge of the insurance industry through continuing education.
- Other tasks as assigned.
Requirements:
Education and Certifications:
- Bachelor’s degree or commensurate experience required
- Insurance industry designations preferred
Experience:
- Knowledge of current state issues, regulations, and industry trends as it relates to claims required
- Demonstrate proficiency with computer software, including Microsoft Office Suite, with advanced skills in Excel required
- Knowledge of COB, Medicare, HIPPA, CPT, ICD-10, COBRA, and benefit plan interpretation preferred
- Knowledge of medical insurance stop-loss contracts and self-funded plans preferred
- Understanding and experience with data analytics preferred
- Experience handling large volumes of stop loss claims preferred
- Understanding and experience with data analytics preferred
Travel:
- Limited travel to Third Party Administrator (TPA) sites.
