Claim Analyst 2
Core
Review, analyze, and adjudicate Critical Illness, Accident, and Hospital Indemnity claims in accordance with policy and regulations.
Role type
Mid-level claims adjudicator
Builds
Claim decisions and payments for insurance customers
Domain
Insurance / Health & Life Claims
Deliverable
client delivery
Required skills
Claims adjudication, medical terminology, vocational analysis, contract interpretation, regulatory compliance, data documentation, payment processing
Preferred skills
Legal terminology, Specialty Product claims experience
Technologies
None stated
Responsibilities
Analyze enrollment, medical, and vocational information to make claim decisions; Maintain fully documented claim files; Communicate with claimants, employers, and medical providers; Prepare claim payments based on contract provisions; Refer complex claims to senior personnel or specialists.
Seniority
Mid-level, hands-on IC