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.

Summary: Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws; achieving results by effective use of all appropriate resources. Calculate benefit payments and communicate claim decisions on new and continuing claims. Provide responsive and caring customer service. All tasks completed under general supervision of management.

Responsibilities include:

• Case Management: Investigate, secure and analyze information pertaining to claimants’ medical condition and occupational demands for disability claims and proof of loss documents for life claims. Identify and resolve fact discrepancies and secure additional documentation as needed within required state and federal timeframes. Review and interpret policy provisions to accurately determine eligibility. Manually calculate benefit payments and communicate claim decisions on new and continuing claims. Manage ongoing claims to the appropriate payment duration. Properly document cases by updating appropriate note system, denoting all action taken on each case. Ensure the company’s reserve liability is accurately established and maintained, when necessary. The Senior Claims Analyst has the ability to perform these functions at a higher demonstrated performance than the Claims Analyst.

• Customer Service – Research and respond to a high volume of customer service phone calls within stated time specifications, following established department guidelines. Ability to work with other team members in management of customer service calls. Resolve issues through effective oral and written communication and by involving appropriate people within, or outside, the department or Company. Effectively and professionally represent the Company in all interactions.

• Resource Development/Training: – Provide support and training to team members as needed. Review and approve claim decisions, disability management strategies and payment recommendations from team members, as needed. Assist in establishing procedural manuals and keeping procedure documents current and up to date.

• Other – Continually improve claim and system knowledge, communication skills and project management methods. Utilize knowledge gained on the job. Perform all reporting functions as assigned. Participate in special projects and other job-related duties as assigned. Model positive behaviors in team and department interactions.

Qualifications include:

• Minimum three-years life and/or disability claim administration experience: solid investigation, analytical and organizational skills along with attention to detail; or the equivalent combination of relevant experience required..
• Must have strong math and decision-making skills.
• Must be able to work in a deadline driven, fast-paced environment.
• Self-motivated with high learning agility.
• Must have excellent verbal and written communication skills with a passion for helping others.
• Must be a self-starter with strong time management skills to prioritize workload, manage and follow-up on numerous tasks.
• Capable of making decisions in the absence of specific directions, independently or with minimal supervision.
• Ability to effectively cope with change and shift gears accordingly in a dynamic environment.
• Must display a strong commitment to teamwork and have the ability to work in a collaborative environment.
• Effective in the use of personal computers and related software. Proficiency in working with Word, Excel and Outlook, Access preferred.

At Health Benefits, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.

The compensation range for this full-time Senior Claims Analyst position is between $17.28/hr. and $32.44/hr. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.

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.