Senior Claims Analyst Lead
4 days ago
Job Description Summary:
The Sr. Health Claims Analyst will play a key role in reviewing and assessing claims, ensuring accurate benefit payouts, and maintaining compliance with policy details, laws, and regulations.
Key Job Responsibilities:
- Analyze and determine eligible benefits based on submitted documents and policy provisions.
- Make adjudication decisions and provide recommendations within prescribed approval limits and turnaround times.
- Collaborate with the Third-Party Administrator (TPA) to review and approve recommendations and decisions.
- Manage accurate records of claims, communications, and resolutions in the claims management system.
Requirements:
- Minimum 3 years of experience in life and health claims processing, insurance, or a related field.
- Bachelor's degree in healthcare administration, business, or a related field (preferred).
- Industry certifications or exams passed (FLMI, etc.).
Benefits:
- A competitive compensation package.
- A dynamic and supportive work environment.
- Opportunities for professional growth and development.
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