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 :
Dedicated, Distraction Free Home Workspace / Office Workspace REQUIREDMust be proficient in MS Word, Excel, and Outlook.Excellent verbal and written communication skills requiredDeeply analytical with the ability and interest to research and "solve the puzzle"Strong attention to detail and an eye for accuracyMust have a good command of the English language, oral, and writtenMust be able to work in a fast-paced environment with demonstrated ability to handle multiple tasksAbility to maintain confidentialityAbility to deal with difficult people and problemsAble to work well in a team environment and with a diverse group of peopleAbility to work mandatory overtime during busy periodsAbility to meet established carrier deadlinesPhysical Demands :
Ability to sit for long periods of timeBenefits :
Medical, Dental, and Vision insuranceEmployer-sponsored Health Savings Account OR Employer-paid enrollment in an Armada supplemental insurance planFlexible Spending Accounts (medical and dependent care)Employer-paid life insuranceEmployer-paid long-term disability insuranceShort-term disability insurance401(k) retirement plan with employer matchPaid time offEight paid holidays per yearFree access to onsite gym at Hunt Valley office locationPatient to Physician matching serviceTravel assistance programEmployee Assistance Program (EAP)Employee referral bonus program – earn up to $1500 per hireProfessional development opportunitiesVoluntary benefits and discount programsHybrid work environmentCompany eventsEmployer-sponsored philanthropy initiativesProbationary 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.