Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits, (a subsidiary of Health Care Service Corporation), you will be part of an organization committed to offering custom services to self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency, and customer support. We are now a subsidiary of Health Care Service Corporation, the largest customer-owned insurance company in the United States and a strategic partner of Health Benefits since 2018, giving us access to increased national scale and support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration, and service to our communities.

At Health Benefits, we value our diverse team of Claim Analysts and we’re looking for new hires that want to learn and grow their careers with us! In this position, you will have the ability to work from home. You will also participate in a 6-week training class, with our new hires scheduled to begin on **** July 31, 2023. Our Trainers provide a detailed program to give you the knowledge and tools to be successful in your new role. Hours for the duration of training will be 8:00 am-4:00 pm CST, Mon-Fri and after training your hours will be 8:00 am - 4:00 pm CST, Mon-Fri.

The Claims Analyst is responsible for 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.

Job Responsibilities include:

• Review, analyze and interpret claim forms and related documents.
• Determine benefit coverage based on clinical edits, plan documents/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.
• Accurately handle correspondence, claims, and referrals in the established timeframes and/or performance guarantees.
• Support the Claims reinsurance team, in the research and resolution of claims as assigned
• Support internal departments in the research and resolution of claims
• 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
• Other duties as needed/assigned.

Job Qualifications:

• High School diploma or GED equivalent
• Ability to work in a fast-paced, customer centric 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
• 1 year of prior Health Insurance experience preferred
• Previous experience in either a medical billing, hospital billing, or claims processing environment a plus

At Health Benefits, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.

The compensation range for this Claim Analyst role is $15.00 - $26.90. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.

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

Associate's Degree. Bachelor's Degree preferred. 1 to 3 years of related experience. Strong Computer skills. Excellent organizational and written/verbal skills.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. We are a VEVRAA Federal Contractor.