Carrier Senior Claims Oversight Analyst

📋 Description

• Review high-value, complex, and over-authority claims, providing informed recommendations to ensure
• Evaluate coverage determinations, appeals, exceptions, and escalated claims, ensuring decisions are
• Oversee delegated claims operations performed by third-party administrators (TPAs), monitoring
• Identify emerging claims trends, operational weaknesses, compliance concerns, and opportunities to
• Support internal and external audits, market conduct examinations, regulatory inquiries, and
• Assist with fraud investigations, claims-related reporting, risk assessments, and mitigation

🎯 Requirements

• At least 5 years of professional experience in insurance claims, claims operations, compliance
• Strong knowledge of claims handling processes, insurance coverage interpretation, claims
• Demonstrated ability to assess complex claims, evaluate exceptions, analyze supporting
• Experience overseeing claims quality, monitoring operational performance, identifying compliance
• Familiarity with third-party administrators, delegated claims authority programs, carrier
• Experience supporting audits, regulatory examinations, compliance initiatives, fraud

🎁 Benefits

• Competitive compensation: Annual base salary ranging from $74,122 to $92,653, depending on relevant
• Remote work: Fully remote working arrangement within the United States.
• Healthcare coverage: Comprehensive medical, dental, and vision insurance.
• Health savings options: Health Savings Account (HSA) and Flexible Spending Accounts (FSA).
• Life and disability protection: Basic life insurance at no cost to employees, along with
• Paid parental leave: Up to 12 weeks of parental leave at 100% pay.