Claims Analyst

Position Summary

The CSA Welfare Fund is seeking an experienced Claims Analyst to join our Operations team. This position is responsible for the timely and accurate adjudication of supplemental health benefit claims while providing exceptional customer service to active and retired members of the Council of School Supervisors and Administrators.

The successful candidate will possess strong analytical skills, extensive knowledge of employee benefit plans, and the ability to interpret plan provisions while maintaining a high level of accuracy and professionalism.

Responsibilities

· Review, analyze, and adjudicate medical, vision, hearing, pharmacy, and supplemental benefit claims in accordance with Welfare Fund policies.

· Interpret plan documents and determine member eligibility and benefit coverage.

· Investigate complex claims and obtain additional documentation when necessary.

· Coordinate benefits with primary insurance carriers.

· Process catastrophic and high-dollar claims requiring additional review.

· Research claim discrepancies and recommend appropriate resolutions.

· Respond to member inquiries by phone and email regarding claim determinations.

· Work collaboratively with Enrollment, Member Services, and Finance to resolve member issues.

· Maintain complete and accurate claim documentation.

· Monitor turnaround times to ensure service standards are met.

· Identify claim trends and recommend process improvements.

· Assist with audits, compliance reviews, and special projects.

· Maintain confidentiality and compliance with HIPAA and applicable regulations.

Qualifications

· Minimum 3 of health benefits or claims administration experience.

· Experience working with self-funded employee benefit plans, union welfare funds, third-party administrators, or health insurance carriers strongly preferred.

· Knowledge of medical terminology, Explanation of Benefits (EOBs), coordination of benefits, and eligibility rules.

· Experience with claims administration systems such as Benesys/Spyglass or similar platforms preferred.

· Strong analytical and problem-solving skills.

· Excellent written and verbal communication skills.

· Exceptional attention to detail and organizational skills.

· Ability to manage multiple priorities in a fast-paced environment.

· Proficiency in Microsoft Office, particularly Excel and Outlook.

Preferred Qualifications

· Experience administering union or municipal employee benefit plans.

· Familiarity with supplemental medical, dental, prescription, and retiree benefits.

· Knowledge of HIPAA and applicable employee benefit regulations.

· Experience handling appeals and complex claim research.

Benefits

· Comprehensive health benefits including dental and vision

· Paid time off

· Stable work environment serving New York City's educational administrators

Pay: From $49,533.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Prescription drug insurance
• Vision insurance

Work Location: Hybrid remote in New York, NY 10006

Salary : $49,533