Medical Claims Analyst

Job Title: Medical Claims Analyst

Department: Claims

Work Environment:  Remote

Company Overview

ASR Health Benefits is a third-party administrator (TPA) based in Grand Rapids, Michigan, with over 40 years of experience helping organizations manage health and benefits programs.  Unlike an insurance carrier, the organization partners directly with employers to design flexible, customized benefits solutions.  Backed by Henry Ford Health, one of the nation's leading health systems, ASR offers access to an extensive network of resources and high-quality care.  Services span self-funded medical plans, dental, vision, wellness, and a range of health benefits solutions designed to support diverse workforces.  The company is focused on making benefits administration simpler, more effective, and more responsive to client needs.

Position Summary:

The Claims Analyst is responsible for the timely and accurate processing and adjudication of routine Medical, Dental, and Vision claims across multiple contracts and plan designs. This role includes applying benefits, fee schedules, and standard claim edits while ensuring compliance with plan provisions, internal policies, HIPAA, and applicable regulatory requirements.

The Claims Analyst will also identify missing or incorrect information, document claim activity thoroughly, and escalate complex claims (including subrogation, Workers’ Compensation, and unusual coverage situations) according to established guidelines.

This role requires strong attention to detail, consistent productivity, and effective communication with members, clients, and providers in a professional and customer-focused manner.

Key Responsibilities:

• Process and adjudicate routine Medical, Dental, and Vision claims accurately and within required timelines.
• Apply benefits, fee schedules, plan provisions, and standard edits correctly.
• Review and interpret benefit plans, contracts, and coverage provisions to support accurate payment decisions.
• Identify missing, incomplete, or incorrect information and initiate appropriate follow-up.
• Maintain accurate documentation, claim notes, and system records.
• Escalate complex claims, exceptions, and non-routine scenarios appropriately.
• Support investigations to resolve coverage questions and determine claim eligibility when needed.
• Assist with research and routing of subrogation and Workers’ Compensation claims based on established processes.
• Communicate effectively (verbally and in writing) with members, clients, and providers to resolve inquiries.
• Maintain confidentiality of member and company information in compliance with HIPAA and internal policies.
• Meet or exceed established quality, productivity, and turnaround expectations.
• Collaborate with team members and other departments to support operational goals.
• Other duties as assigned.

Preferred Skills and Qualifications:

• Basic medical terminology and insurance concepts
• Strong computer and data entry skills
• High attention to detail and accuracy
• Analytical and problem-solving skills
• Ability to follow documented procedures and guidelines
• Strong time management and ability to prioritize workload
• Effective written and verbal communication skills
• Customer service orientation with internal and external stakeholders
• Ability to learn quickly and adapt to process or policy changes
• Working knowledge of coordination of benefits (COB) preferred
• Commitment to confidentiality and compliance
• Agreement that your likeness (e.g., name, image, voice, and/or video) may be used in internal and external materials with customers or prospective customers.

Performance Metrics / Expectations:

• Accuracy: ≥ 97–98% based on quality audits
• Productivity: Meets established daily/weekly claim volume standards
• Production Volume (Routine Claims):
• Estimated: 25–40 claims per hour
• Daily average: 200–320 claims per day
• Turnaround Time: Processes claims within required SLAs
• Quality Compliance: Minimal rework, errors, or audit findings
• Attendance & Reliability: Meets schedule adherence expectations
• Training Progression: Demonstrates consistent improvement throughout onboarding

Production expectations may vary based on claim complexity, system functionality, plan requirements, training status, and business needs.

Preferred Experience:

• High school diploma or equivalent required
• 0–1 year of medical claims or related experience preferred
• Additional education or certifications are a plus

Work Environment:

• Remote work structure (work-from-home), with occasional in-office work required based on business needs.
• Fast-paced, deadline-driven environment requiring accuracy, efficiency, and consistent productivity.
• Must be able and willing to work overtime as needed based on department demands.

Essential Functions:

This role may require extended sitting, regular computer and office equipment use, clear communication, and occasional lifting of up to 10–15 pounds. Reasonable accommodations for individuals with disabilities will be provided as needed.

Confidentiality: This position involves access to protected health information (PHI) and other sensitive data. Employees are expected to maintain strict confidentiality in accordance with HIPAA, company privacy policies, and all applicable federal and state regulations.