HC and Insurance Operations Analyst

Position:
Claims Case Manager

Must live in the Continental United States

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

Role Overview

We are seeking a dedicated Claims Case Manager to provide comprehensive claim servicing to our insurance policyholders. This role involves managing the entire claims process from intake to final decision, ensuring frequent status updates to claimants through their preferred communication channels (email, phone, mail, etc.). The ideal candidate will have a strong analytical skill set, a thorough understanding of the claims process, and the ability to communicate with empathy and detail.

Pay for this Role $26hr.

Key Responsibilities End-to-End Claim Management

Handle every aspect of the claim process, from intake to final decision.

Status Updates

Provide frequent updates to claimants through their preferred communication channels.

Document Review

Thoroughly review medical documents, claim forms, and policy notes.

Communication

Interact with claimants with empathy and attention to detail.

Team Collaboration

Work with team members to ensure high-quality service and resolution of issues.

Record Keeping

Maintain accurate records and reports throughout the claims process.

Data Analysis

Compile and analyze data to identify trends and perform root cause analysis.

Basic Qualifications Experience

2 years in an analytical role reviewing medical benefits and claims.
2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease).4 years of experience reviewing and assessing medical records.

Experience articulating claim requirements clearly and concisely.

Education

Minimum high school diploma or GED; college degree preferred.

Work Environment

At least 1 year of experience working from home with proven productivity and quality.

Designated quiet area for completing calls.

Responsibilities Claim Initiation

Gather information and initiate claims through various channels.

Detailed Logging

Log and update pertinent information throughout the claim lifecycle.

Omni-Channel Correspondence

Communicate required medical records and claim information via email, mail, and phone.

Proactive Follow-Up

Follow up on pending claims and assist in gathering required medical records.

Benefit Calculation

Calculate benefit amounts and process payments through the claims system.

Multitasking

Manage a caseload of active claims and perform end-to-end steps.

Attention to Detail

Ensure accuracy and organization in logging, tracking, and reviewing claims. Identify and flag potential fraudulent activities.

Collaboration

Work with management and team members to address service issues and concerns.

Empathy

Communicate with claimants with empathy and a willingness to help.

Any state specific certification related to performing the job duties shall be sponsored by the company and successful completion of the certification program is desired.

Required schedule availability for this position is between Monday-Friday 7:00 am to 7:00 pm (Central Time), OT during evenings and Saturdays could also be required based on business need, particularly during the months of Nov – Feb.

New hire must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.

Must Pass Drug screen

Must Pass a background check with Education check and employment verification check.

Remote Working and Technology…