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. 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.  

We are seeking a Claims Analyst who will  be 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.  

You will participate in a 6-week training class that is scheduled to begin on April 3, 2023.    Hours for the duration of training will be 8:00 am-4:00 pm CST and after training your hours will remain at 8:00 am - 4:00 pm CST. 

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:

• At least one year of prior health insurance experience preferred
• Self-Funded Insurance/Benefits and/or TPA experience preferred
• Knowledge of medical procedure and diagnosis coding preferred
• 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
• Knowledge of medical terminology
• Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools
• Previous experience in either a medical billing, hospital billing, or claims processing environment a plus
• Must be able to work a 37.5 hr. work week with between the hours of 8:00 AM  - 4:00 PM CST MON-FRI.

Come join Health Benefits! Join a team that will not only utilize your current skills but will enhance them as well. 

If you are a Colorado or New York 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