Senior Claims Analyst

POSITION SUMMARY

The Senior Claims Analyst will take a proactive role in managing and leading special projects within the department. This position focuses on the efficient processing of backlog claims, particularly aged claims, ensuring timely and accurate completion. The role involves running year-end reports and distributing them to the department, assisting with UnitedHealthcare (UHC) errors, escalations, and aging claims, and supporting the Claims Manager in meeting the department's needs.

DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:

• Lead and manage special projects assigned to the department, ensuring successful completion within set timelines.
• Handle backlog processing with a particular emphasis on aged claims, improving efficiency and reducing outstanding claim volumes.
• Generate and distribute comprehensive year-end reports to the department, ensuring accuracy and timeliness.
• Assist in resolving UHC errors and escalations, providing solutions and maintaining communication with relevant stakeholders.
• Collaborate closely with the Claims Manager to support departmental needs and objectives, contributing to a cohesive and productive work environment.

Other job duties include, but are not limited to the following:

• May perform other duties as assigned.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

• A minimum of 2 years of experience in claims processing.
• Basic understanding of medical coding, including ICD-10, and current medical terminology.
• Familiarity with UnitedHealthcare (UHC) processing protocols and procedures.
• Exceptional attention to detail and organizational skills, ensuring accuracy and efficiency in all tasks.
• Ability to work independently and as part of a team, demonstrating strong problem-solving skills and a proactive approach to responsibilities.
• Strong analytical skills with the ability to interpret and utilize data effectively.
• Excellent communication skills, both written and verbal, for effective interaction with team members and external partners.
• Proficiency in relevant software and tools used for claims processing and reporting.

OTHER DETAILS
Supervisory Responsibilities

None.

Work Environment

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.

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