Claims Analyst

Company Overview:

ASR Health Benefits is a rapidly growing third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125, and consumer-directed health plans.  We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

Position Summary:

The Claims Analyst is responsible for the timely and accurate processing and adjudication of Medical, Dental, and Vision claims across multiple and varied contracts and plans. This role involves researching coverage situations, handling subrogation and Workers’ Compensation claims, and conducting investigations to resolve coverage questions and determine claim eligibility. 

The Claims Analyst must communicate effectively with members, clients, and providers both verbally and in writing while maintaining productivity expectations of 100–145 processed claims per day.

Work Environment:

• This position follows a remote work structure, allowing employees to work from home, based on specific tasks or personal work preferences.  There may be times when working in the office will be required, if applicable.

Key Responsibilities:

• Process and adjudicate Medical, Dental, and Vision claims accurately and within established timelines.
• Review and interpret benefit plans, contracts, and coverage provisions to ensure correct payment determinations.
• Research and resolve complex claims, including subrogation and Workers’ Compensation cases.
• Conduct thorough investigations to determine claim eligibility and resolve coverage questions.
• Communicate professionally and effectively with members, clients, and providers to resolve inquiries and issues.
• Maintain confidentiality of member and company information in accordance with HIPAA and company policies.
• Meet and exceed established productivity and quality standards.
• Collaborate with team members and other departments to support operational goals.
• Perform other duties and responsibilities as assigned.

Skills and Competencies:

• Strong computer and data entry skills.
• Excellent analytical and problem-solving abilities.
• High attention to detail and accuracy.
• Ability to multi-task and prioritize workload effectively.
• Excellent written and verbal communication skills.
• Ability to work independently and meet deadlines.
• Strong customer service orientation when interacting with internal and external stakeholders.
• Ability to learn quickly and adapt to process or policy changes.
• Working knowledge of medical terminology and coordination of benefits.
• Commitment to maintaining member confidentiality and compliance with privacy regulations.
• Must be able and willing to work overtime as needed based on business or department demands.

Qualifications and Requirements:

• Education: High school diploma required; additional education or certifications preferred.
• Experience: Minimum of two (2) years in claim processing, data entry, or customer service within a TPA/Insurance environment.

If you are a motivated individual who thrives in a dynamic environment, with a passion for the insurance industry and building relationships, we encourage you to apply!

Please visit www.asrhealthbenefits.com and navigate to the CAREERS link on the homepage to view ASR’s current openings.

ASR is an equal opportunity employer committed to creating an inclusive environment for all employees.