Claims Analyst

Claims Analyst The Claims Analyst is responsible for providing assistance to the Claims Manager while ensuring that claims are properly adjudicated in accordance with our Policy and the underlying Plan/Group Documents. This position will report to the Claims Manager. Essential Elements Review, analyze, manage, and adjudicate claims on the Stop Loss and Excess of Loss book of business to determine action to be taken. Research and resolve 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, files, and company turnaround time standards. Maintain knowledge of the 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 Experience handling large volumes of stop loss claims preferred Travel: Limited travel to Third Party Administrator (TPA) sites.

Created: 2026-03-06