Summary:
This key role is at the heart of what we do at Armada - pay our members claims! The Claims Analyst is responsible for reviewing portal entry claims, conducting error correction and quality control reviews, as well as final adjudication of paper and electronic claims.
The ideal Claims Analyst will be analytical and have an interest in digging in to find the right answer, all while meeting our high excellence and service standards.
They will have good communication skills and be comfortable working with high-profile clients.
Tasks/Responsibilities:
Apply product, plan provisions, SOPs, benefit limits and policy exclusions to determine the next steps for a claim
Process claims, including all associated tasks - benefit eligibility verification, determining the appropriateness of a claim, etc
Acquire additional claims substantiation, as needed
Complete related tasks such as claim identifications, member communication, and closing of said claims
Use multiple systems and tools to answer service requests and inquiries received from various channels
Research and resolve other general customer account inquiries as appropriate
Review charges and use of payment or denial codes within established guidelines and standards
Maintain records, files, and documentation
Meet or exceed the standards of department production and quality
Such other duties or tasks to assist the department of organization as the supervisor may deem necessary.
Skills/Requirements:
Must be proficient in MS Word, Excel, and Outlook.
Excellent verbal and written communication skills required
Deeply analytical with the ability and interest to research and "solve the puzzle"
Strong attention to detail and an eye for accuracy
Must have a good command of the English language, oral, and written
Must be able to work in a fast-paced environment with demonstrated ability to handle multiple tasks
Ability to maintain confidentiality
Ability to deal with difficult people and problems
Able to work well in a team environment and with a diverse group of people
Ability to work mandatory overtime during busy periods
Ability to meet established carrier deadlines
Physical Demands:
Ability to sit for long periods of time
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