Claims Analyst I - Data Specialist

Job Description JOB SUMMARY: SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage. The Claims Analyst I – Data Specialist role is essential to the Claims department at SBMA. They manage import/export files from multiple vendors. In addition to processing claims in all workflow queues to ensure processing times meet company turnaround times (TATs) and timely review and reprocessing of claims as indicated. The Claims Analyst I – Data Specialist will perform administrative tasks and services to support the effective and efficient operations of the organization’s claims department. This position is essential to SBMA's success. To perform this job successfully, an individual must be able to satisfactorily perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. RESPONSIBILITIES AND DUTIES (Included but not limited to): • Manage the import/export of all claims-related data files from various vendors • Knowledge of medical claims adjudication • Review of processed claims and reprocessing when necessary • Claims reporting – daily and weekly reporting • Appeals management • NSA/Open Negotiations/IDR • Other responsibilities as needed. REQUIRED EDUCATION AND EXPERIENCE: • High School Diploma • Two years or more of HealthPac experience • Two years or more of medical claims adjudication experience PREFERRED EDUCATION AND EXPERIENCE: • Bachelor’s degree in a related area • Three years or more of HealthPac experience • Three years or more of medical claims adjudication experience KNOWLEDGE, SKILLS, AND ABILITIES: • Excellent verbal and written communication skills. • Proficient in HealthPac software. • Excellent interpersonal and customer service skills. • Proficient in Microsoft Office Suite or related software. • Excellent organizational skills and attention to detail. • Basic understanding of clerical procedures and systems such as recordkeeping and filing. • Ability to work independently. PHYSICAL REQUIREMENTS: • Prolonged periods of sitting at a desk and working on a computer. • Must be able to lift up to 15 pounds at times. Pay Details: Hourly: $24 - $26 Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant. To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisure’s property, and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisure’s Human Resources Talent Department.