What are the responsibilities and job description for the Claims Analyst position at BCS Financial Corporation?
Position Overview:
The Claims Analyst is responsible for providing assistance to the Director, Claims and Clinical while ensuring that claims are properly adjudicated in accordance with our contract and the underlying Plan/Group contracts.
This position will report to the Director, Claims and Clinical.
Essential Elements
- Review, analyze, manage and adjudicate claims on all applicable lines of business to determine action to be taken
- Research and resolves claim issues by identifying and analyzing problems and/or risks, and assembling the documentation needed to support the recommendation to resolve the problem
- Maintain applicable logs, and files
- Maintain knowledge of insurance industry through continuing education
- Other tasks as assigned
Requirements:
Education and Certifications:
- Bachelor’s degree or commensurate experience required
- Insurance industry designations preferred
Experience:
- Knowledge of current state issues, regulations and industry trends as it relates to claims required
- Demonstrate proficiency with computer software including Microsoft Office Suite, with advanced skills in Excel required
- Knowledge of COB, Medicare, HIPPA, CPT, ICD-10, COBRA and benefit plan interpretation preferred
- Knowledge of medical insurance stop-loss contracts and self-funded plans preferred
- Understanding and experience with data analytics preferred
Travel:
- Limited travel to Third Party Administrator (TPA) sites
