Claims Processor, Advanced

The Accumulations Team is responsible for managing and maintaining member accumulations by researching, auditing, updating and posting data to ensure accurate deductible and out-of-pocket balances. In this role you will monitor inventory, track aging, prioritize audit requests, and process member accumulation transfers between plans according to system guidelines. Additionally, the team member collaborates with business partners, assists with audits and remediation efforts, supports training and serves as a subject matter expert for testing and documentation reviews. The Accumulations Team Member will report to the Claims Operations Supervisor.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma required
• 5 years of previous experience required
• Requires broad knowledge of operational systems and practices within Claims Processing
• Proficiency in front and back-end processing with the ability to not only identify errors but to analyze and resolve them
• Demonstrated ability in processing multiple claim types or specialties
• Deep understanding of end-to-end claims processing fundamentals
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, Power Point, and Word
• Ability to work independently as well as in a team environment
• Strong ability to manage time effectively and detailed research skills

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Your Work

In this role, you will:

• Research accumulations and update accordingly

• Independently process complex and high-risk claims across multiple products or specialties

• Pull, format and send reporting to necessary teams

• Reviews applications and recommends system edits/changes as needed

• Be given special processing assignments; coordinate with other departments for resolution if needed

• Consistently exceed performance metrics and quality standards

• Manage time effectively, multi-task, demonstrate detailed research skills, meet deadlines with excellent quality

• Serve as a subject matter resource for selected claim types, providing guidance to peers

• Identify, analyze, and resolve system and processing errors with minimal escalation

• Assist with training, documentation review, and workflow support; act as backup to lead roles

• Other duties as assigned

Your Work

In this role, you will:

• Research accumulations and update accordingly

• Independently process complex and high-risk claims across multiple products or specialties

• Pull, format and send reporting to necessary teams

• Reviews applications and recommends system edits/changes as needed

• Be given special processing assignments; coordinate with other departments for resolution if needed

• Consistently exceed performance metrics and quality standards

• Manage time effectively, multi-task, demonstrate detailed research skills, meet deadlines with excellent quality

• Serve as a subject matter resource for selected claim types, providing guidance to peers

• Identify, analyze, and resolve system and processing errors with minimal escalation

• Assist with training, documentation review, and workflow support; act as backup to lead roles

• Other duties as assigned