Sr Claims Analyst - LHB

Dearborn Group; Overland Park, Northern (KS, KY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

The Dearborn Group is seeking a Senior Claims Analyst to support a Claims Unit and vendor staff, serving as a liaison for internal departments. Responsibilities include adjudicating medical, dental, and vision claims and processing related inquiries in compliance with plan documents and timelines.

You will advise team members on claim processing procedures, analyze documents and SPDs, and collaborate with clients, providers, and staff across levels to resolve complex claim issues.

Qualifications

• High School diploma or GED; 3 years of medical claim processing experience.
• Ability to work in a fast-paced, customer-centric production environment.
• Excellent verbal and written communication skills.
• Ability to work effectively with members, providers, clients and staff at all levels.
• Strong analytical and critical thinking to follow instructions and improve processes.

Responsibilities

• Adjudicate and process medical, dental, vision, or related claims.
• Handle related correspondence and electronic inquiries.
• Support Claims Unit and vendor staff; liaison with internal departments.
• Advise team members on claim processing procedures.
• Ensure adherence to plan documents and processing guidelines.

Skills

Communication skills

Fast-paced environment

Interpersonal skills

Critical thinking

Self-directed

Education

High School diploma or GED

Tools

MS Excel

MS Word

Job description

At Dearborn, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position includes a variety of claim administrative and technical tasks that support a Claim Unit and/or vendor staff, as well as the Claims Team and serves as a liaison for any internal departments. In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times.

Also advise team members regarding claim processing procedures.

Life & Disability - Sr Claims Analyst Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws; achieving results by effective use of all appropriate resources. Calculate benefit payments and communicate claim decisions on new and continuing claims. Provide responsive and caring customer service. All tasks completed under general supervision of management.

Required Job Qualifications:

• High School diploma or GED equivalent 3 years prior medical claim processing experience
• Ability to work in a fast-paced, customer centric & production driven environment
• Excellent verbal and written communication skills
• Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
• Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram form
• Flexible; open to continued process improvements
• Self-directed individual who works well with minimal supervision
• Good leadership, organizational and interpersonal skills
• Ability to effectively handle with complex situations and reach resolution
• Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
• Ability to adapt to various system platforms, and to effectively use MS Excel/Word

Preferred Job Qualifications:

• Health Insurance/Third Party Administrator