Sr Claims Analyst - LHB

Are you ready to truly make a difference, shaping the very foundation of a thriving business from anywhere in the world? At CareAllies, we believe our people are the heart of everything we do, and we’re passionate about fostering careers that are not only rewarding but genuinely fulfilling. We empower our team members with personalized growth paths, ensuring every step forward is a meaningful one. If you're an experienced and meticulous claims professional eager to contribute your expertise to a dynamic, fully remote environment as a Sr Claims Analyst focusing on Life & Disability, then we invite you to join our team.

Overview

As a Senior Claims Analyst at CareAllies, you'll play a pivotal role, handling a diverse range of administrative and technical tasks that provide essential support to our Claim Units, vendor partners, and the broader Claims Team. This position also serves as a crucial liaison for various internal departments, ensuring seamless communication and operational efficiency. You will be responsible for the accurate adjudication and processing of medical, dental, vision, and other related claims. This includes diligently managing associated correspondence and electronic inquiries for assigned groups. Every claim and inquiry you handle will adhere strictly to established plan documents, processing guidelines, and total turnaround time expectations. A key part of your role involves securing and analyzing comprehensive claim information to make precise life and disability benefit determinations. You will ensure all decisions comply with policy provisions as well as all relevant state and federal laws, utilizing effective methods to achieve accurate outcomes.

Key Responsibilities

Accurately adjudicate and process medical, dental, vision, or other related claims for assigned groups.
Manage and respond to claim-related correspondence and electronic inquiries promptly and professionally.
Provide expert guidance to team members on claims processing procedures and best practices.
Secure and meticulously analyze claim information to determine life and disability benefits.
Ensure all benefit determinations strictly adhere to policy provisions and all applicable state and federal laws.
Support the Claim Unit and/or vendor staff with various administrative and technical tasks.
Act as a primary liaison, fostering clear communication between the Claims Team and internal departments.

Requirements

To excel in this fully remote, worldwide role, we are looking for a professional who brings a proven track record and a keen eye for detail. You should be adept at navigating complex claim scenarios and committed to maintaining the highest standards of accuracy.

Demonstrated experience in claims adjudication and processing, particularly with medical, dental, vision, and other related claims.
Solid understanding of life and disability claim benefit determination processes.
In-depth knowledge of policy provisions, claims processing guidelines, and relevant state and federal laws governing benefits.
Exceptional analytical and problem-solving skills to assess intricate claim information.
Excellent communication and interpersonal abilities for advising team members and serving as an internal liaison.
A strong commitment to meeting established turnaround times and maintaining data integrity.
Ability to work effectively and independently in a fully remote, global environment.

What You'll Gain

Joining CareAllies means stepping into an environment where your contributions are genuinely valued and your professional journey is actively supported. You will benefit from:

The opportunity to be a cornerstone of our business success, directly impacting our operational excellence.
Access to curated development plans designed to foster your continuous growth and career advancement.
A rewarding and fulfilling career experience within a collaborative and empowering culture.
The flexibility and convenience of a fully remote work model, allowing you to thrive from anywhere in the world.
The chance to apply your expertise in a critical role, making precise decisions that affect individuals' lives.