Senior Benefits Claim Analyst

Job description

Required Qualifications · Bachelor’s degree in Finance, Healthcare Administration, Business, or related field · 5–10+ years of experience in benefits, claims analysis, or payer-side operations · Strong understanding of: o Medical and pharmacy claims o Claims adjudication and payer methodologies o Self-funded plans and stop-loss mechanics o Benefits administration and billing processes · Advanced Excel and data analysis skills Preferred Qualifications: · Experience with a major health insurer (BCBS experience strongly preferred) · Experience working with TPAs, stop-loss carriers, and pharmacy benefit managers · Experience supporting or managing benefits within a self-funded employer environment Qualifications: Position Summary: The Senior Benefits Claim Analyst is responsible for the day-to-day administration and ongoing optimization of the company’s health and welfare benefits programs, with a strong emphasis on claims analytics, financial oversight, and vendor performance validation. This role combines hands-on operational ownership with deep analytical capability to ensure the accuracy, integrity, and performance of the company’s self-funded health plans. The Analyst will manage...