Senior Medical Claims Analyst

2 weeks ago


Glastonbury, Connecticut, United States Complete Staffing Inc Full time

Position: Senior Medical Claims Analyst

Complete Staffing Inc is collaborating with a prominent third-party insurance provider seeking to recruit two professionals with substantial experience in medical claims management.

Key Qualifications:

  1. Leadership Experience: Minimum of 4 years in the field, with a background in supervising a small team or demonstrating readiness for advancement.
  2. Bilingual Requirement: Proficiency in both English and Spanish is essential.

Compensation:

  • Lead Position: $26/hour
  • Bilingual Position: $23/hour

This role demands a proactive approach in a dynamic environment, requiring exceptional interpersonal and communication skills, meticulous attention to detail, and a strong capacity for multitasking and prioritization. Additionally, robust analytical skills are crucial.

Responsibilities Include:

  • Evaluating covered insurance losses by reviewing policy provisions.
  • Establishing proof of loss through documentation and external information gathering.
  • Documenting claims by completing necessary forms, reports, and logs.
  • Analyzing claims to detect and prevent fraudulent activities.
  • Preparing comprehensive reports by collecting and summarizing relevant data.
  • Resolving claims through the approval or denial of documentation, calculating benefits, and determining settlement amounts.
  • Ensuring compliance with legal standards by adhering to company policies and state and federal regulations.
  • Maintaining high-quality customer service by addressing inquiries and providing assistance.
  • Offering legal support by compiling documentation for settlement processes.
  • Safeguarding operations by ensuring confidentiality of claims information.
  • Fostering positive relationships with insurance departments.

We are looking for dedicated individuals who can contribute to our mission of delivering exceptional service and maintaining the integrity of our claims process.



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