Sr Claims Analyst - LHB
Core
Adjudicate and process medical, dental, vision, life, and disability claims; calculate benefit payments and make benefit determinations in accordance with policy provisions and laws.
Role type
Senior Claims Analyst (Life & Disability)
Builds
Claim decisions and benefit payments for insurance plans
Domain
Health Insurance / Claims Administration
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
claim adjudication, benefit calculation, policy interpretation, state/federal law compliance, customer service, critical thinking, document analysis, MS Excel/Word proficiency
Preferred skills
health insurance third-party administration experience, medical terminology knowledge, Access proficiency
Responsibilities
Accurately adjudicate and process medical, dental, vision, life, and disability claims; calculate benefit payments and communicate claim decisions; advise team members on claim processing procedures; handle complex situations and reach resolutions; analyze Summary Plan Descriptions (SPDs)
Seniority
Senior, hands-on IC