Claims Processor
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Job Description
Claims and Appeals Processor adjudicating medical claims and resolving appeals. Supporting Sana’s mission to simplify healthcare for small and midsize businesses.
Responsibilities:
- Ensure the timely and accurate adjudication and payment of medical claims, following health plan policies and procedures
- Consult with team members, care partners, and advisors as necessary
- Maintain accurate and up-to-date notes of all claims processed
- Process appeals and disputes by gathering and verifying claim information, researching and resolving claim issues, and communicating outcomes to appropriate parties
- Become an in-house expert on claims-related matters and provide answers and support to Customer Success and Customer Support teams
- Identify operational issues and escalate them to the appropriate internal team
- Contribute to teamwide goals to improve claims processes and integrate additional functions into daily operations
- Work independently and as part of a team to meet deadlines and daily processing quotas; complete daily and weekly targets
Requirements:
- Two-year degree and/or two years of claims adjudication and processing experience
- Unparalleled attention to detail
- Excellent written and verbal communication skills
- Ability to work independently and as part of a team
- Fast learner; entrepreneurial; self-directed
- Ability to meet deadlines and work under pressure
- Experience in claims processing; knowledge of insurance principles and procedures is a plus
Benefits:
- Remote company with a fully distributed team – no return-to-office mandates
- Flexible vacation policy (and a culture of using it)
- Medical, dental, and vision insurance with 100% company-paid employee coverage
- 401(k) with company match, FSA, and HSA plans
- Paid parental leave
- Short and long-term disability, as well as life insurance
- Competitive stock options are offered to all employees
- Transparent compensation & formal career development programs
- Paid one-month sabbatical after 5 years
- Stipends for setting up your home office and an ongoing learning budget
- Direct positive impact on members’ lives – wait until you see the positive feedback members share every day
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