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Claim Analyst

Full Time
Posted 3 days ago
Job description

Health Benefits’ mission is to improve wellbeing – for everyone. It is a mission grounded in a belief in equality and born from our caring culture. It is a culture we can only realize by building trust. Trust established by ensuring associates feel respected, valued and heard. At Health Benefits, you’ll work collaboratively to transform lives and help people, communities and businesses thrive. Flourish in a culture of diversity and inclusion where appreciation, mutual respect and trust are constants, not just for our customers but for ourselves. At Health Benefits, we have a commitment to welcoming people, no matter their background, identity or experience, to a workplace where they feel safe being their whole, authentic selves. A workplace made up of diverse, empowered individuals that allows ideas to thrive and enables us to bring the best to our colleagues, clients and communities.

In this position, you will be responsible for providing quality service by timely and accurately processing medical, dental, vision, disability or other claims for assigned groups, according to established plan documents and claim processing guidelines. This position will also serve as a back-up to Customer Service for overflow calls and could be responsible for working with providers, employees/members and clients to accurately respond to telephone or electronic inquiries regarding benefits, eligibility, and claims status.

Job Responsibilities include:

  • Review, analyze and interpret claim forms, medical bills and reports to determine nature of illness/injury.
  • Determine benefit coverage based on system plan and clinical edits, plan documents and booklets, benefit reference documents, Claim Reference Manuals and claims-related memoranda, and reports.
  • Appropriately investigate, pend and refer claims based on claim procedures and guidelines.
  • Handle correspondence, pending claims and referrals in a timely manner based on claim procedures and guidelines.
  • Correctly and timely adjudicate claims using PowerSTEPP and WorkQueue based on the above.
  • Communicate via telephone, email, electronic messaging, fax, or written letter with employees/members, providers of service, clients and/or other insurance carriers to ensure proper claim processing.
  • Back-up other team members and Customer Service based on business need.
  • Other duties as needed/assigned

Job Qualifications:

  • Previous experience in either a medical billing, hospital billing, insurance or claims processing environment is strongly preferred.
  • Ability to work in a fast-paced, customer service and production driven environment
  • Effective verbal and written communication skills
  • Ability to work effectively with team members, employees/members, providers, and clients
  • Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
  • Flexible; open to continued process improvement
  • Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word.
  • Previous claim processing experience preferred.
  • Self-Funded Insurance/Benefits and/or TPA experience a preferred.
  • Knowledge of medical terminology, procedure and diagnosis coding a plus.
  • Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools a plus!

Come join Health Benefits! Join a team that will not only utilize your current skills but will enhance them as well. Trustmark benefits include health/dental/vision, life insurance, FSA and HSA, 401(k) plan, Employee Assistant Program, Back-up Care for Children, Adults and Elders and many health and wellness initiatives. We also offer a Wellness program that enables employees to participate in health initiatives to reduce their insurance premiums.

If you are a Colorado resident and this role is a field-based or remote role, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran or disability.

Required Skills

Required Experience

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