Senior Process Analyst_Claims

Job Summary

This job takes the lead in providing more complex claims adjudication services typically as part of a Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies.Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. May mentor less experienced team members.

Essential Responsibilities

• Analyzing, validating, updating processing claims, as well as meeting defined scope, targets and SLAs.
• Collaborating with customers, business analysts, partners, and IT team members to understand business requirements that drive the innovation and quality. Concentrates on providing innovative solutions to more complex business needs.
• Providing required support for new joiners once they gain experience.
• Performs work in compliance with all Highmark and Highmark IT standards, policies and procedures.
• Effectively communicates with team members, customers, partners and management, including assisting with or conducting more complex walkthroughs, reporting production quality status.
• Other duties as assigned or requested.

Experience / Requirements

• Greater than 1.5 years of experience in claims adjudication
• Bachelors or Masters degree in any discipline
• Good verbal and written skills
• Good analytical and interpersonal skills
• Good to have: AHM or any equivalent certification
• Adjustments and Offset/Recovery knowledge