Claims Analyst

Job Description

Job Description

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 :

Physical Demands :

Benefits :

Probationary Period :

This role will have three (3) month probationary period on-site . During which management will have an opportunity to determine whether a person is able to perform all required duties of employment. Details related to job expectations and production metrics will be provided by management.

Position is hybrid during new hire training period (in-office Tuesday - Thursday, remote Monday and Friday).

Following the initial training period, the role will be primarily remote with the requirement to be in office Tuesday - Thursday during the second week of the month.

40+ hours per week. Overtime required during busy seasons.