HC and Insurance Operations Analyst

End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision. Status Updates: Provide frequent updates to claimants through their preferred communication channels. Document Review: Thoroughly review medical documents, claim forms, and policy notes. Communication: Interact with claimants with empathy and attention to detail. Team Collaboration: Work with team members to ensure high-quality service and resolution of issues. Record Keeping: Maintain accurate records and reports throughout the claims process. Data Analysis: Compile and analyze data to identify trends and perform root cause analysis. Claim Initiation: Gather information and initiate claims through various channels. Detailed Logging: Log and update pertinent information throughout the claim lifecycle. Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone. Proactive Follow-Up: Follow up on pending claims and assist in gathering required medical records. Benefit Calculation: Calculate benefit amounts and process payments through the claims system. Fraud Detection: Identify and flag potential fraudulent activities. Multitasking: Manage a caseload of active claims and perform end-to-end steps. Attention to Detail: Ensure accuracy and organization in logging, tracking, and reviewing claims. Collaboration: Work with management and team members to address service issues and concerns. Empathy: Communicate with claimants with empathy and a willingness to help. Management monitors all technical issues and agent downtime. Experience: 2 years in an analytical role reviewing medical benefits and claims. 2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease). 4 years of experience reviewing and assessing medical records. Experience articulating claim requirements clearly and concisely. Education: Minimum high school diploma or GED; college degree preferred. Work Environment: At least 1 year of experience working from home with proven productivity and quality. Designated quiet area for completing calls. To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology. Technology 1.