Job Description

JOB TITLE: Medical Claim Analyst                                      

DEPARTMENT(S): Claims Department

REPORTS TO: DEBBIE STAGGS, CLAIMS DEPARTMENT SUPERVISOR

JOB SUMMARY: The Claims Analyst for a TPA plays a key role in the Participant’s perception of The William C. Earhart Company, Inc. and the level of customer service we provide.  The duties of this position include proper adjudication of all claim types and customer service for the Funds that are assigned. 

The Claims Analyst serves as a liaison on matters relating to the benefit claim process. In this role, the Claims Analyst serves as the expert on all Trust Welfare Benefit Plans assigned including but not limited to administrative issues, HIPPA regulations, policies and procedures, timely and accurate processing of benefits with excellent customer service.

MINIMUM REQUIREMENTS

Ø  Prefer recent claim adjudication office experience (beneficial if with a TPA or similar office setting)

Ø  Recent customer service experience in health insurance setting

Ø  High school graduate or acceptable equivalent level of education

Ø  Proficient with 10 key, PC, Word, Email, Excel, Enrollment/Eligibility software

Ø  Ability to read and understand all Summary Plan Descriptions, documentation and written directions. Including but not limited to understanding and applying contract language.

Ø  Excellent verbal and written communication skills –

Ø  Strong interpersonal skills

Ø  Ability to work under pressure independently while making appropriate decisions based upon established procedures

Ø  Mathematical skills and detail accuracy

Ø  Excellent organizational skills

Ø  Excellent attendance

Ø  Strong understanding of medical terminology

Ø  Team player

SUMMARY OF ESSENTIAL JOB FUNCTIONS

This position requires the employee to be responsible and proficient in, but not limited to the following:

¨       Adhere to all established policies and procedures

¨       Review and resolve benefit related discrepancies

¨       Request Trust required information necessary to determine benefit allowance.

¨       Adjudicate all claim types accurately and thoroughly

¨       Meet minimum production standards as established by the Claims Manager.

¨       Identify and communicate claims system and/or billing problems to the Lead Analyst and/or Claims Manager.

¨       Resolve personal daily aging claims and error reports

¨       Resolve and handle all attention mail daily

¨       Answer phone calls timely and accurately. Research the call and seek assistance from a Lead Analyst if necessary.

¨       Resolve as assigned / identified daily reports

¨       Meet or exceed claim accuracy and timeliness standards established by the Claims Manager.

¨       Research and correct all errors as identified by internal/external claim audit. 

¨       Cross training on other Funds as assigned

¨       Must have a thorough knowledge of each Trust’s policies and procedures and apply them to the daily duties of this position.

The above duties are not to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time as needed.

Company Description

The William C. Earhart Company, Inc, a third party administrator (TPA) of employee benefits, has been a leader in the benefits industry since inception. Founded by Bill Earhart for 39 years the company has successfully transitioned to third generation leadership, and is well on its way to establishing the continued commitment to excellence in service and knowledge within the family's third generation employees. Earhart employees are dedicated professionals whose expertise ranges from health claim and pension adjudication through accounting, information technology, and financial administration.