Senior Claims Analyst

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.

SBMA has a current need for a full-time Senior Claims Analyst. The Senior Claims Analyst is a critical member of SBMA's Claims Department, responsible for overseeing the most complex claims adjudication tasks and ensuring operational excellence across all claims functions. This role provides advanced support, guidance, and informal mentorship to Claims Analyst I and II team members, acting as a subject matter expert (SME) for HealthPac and SBMA's internal processes. The Senior Claims Analyst helps streamline workflows, improve accuracy and turnaround times, and support continuous improvement efforts across the department. This position plays a key role in resolving escalated issues, developing SOPs, and enhancing departmental efficiency.

SUPERVISORY RESPONSIBILITIES:

• No direct reports but serves as a lead and informal mentor to Claims Analyst I and II staff.
• May assist with onboarding and training of new Claims Analysts.
• Acts as point of contact for escalated claims-related questions or issues within the team.

RESPONSIBILITIES AND DUTIES (Included but not limited to):

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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.

• Review and process complex or high-priority claims, including escalated or disputed claims.
• Provide quality assurance and auditing of Claims Analyst I and II work to ensure compliance with turnaround time (TAT), accuracy, and best practices.
• Serve as department liaison to IT or vendor support on claims system-related issues or enhancements.
• Lead training sessions and support the professional development of junior analysts.
• Assist the Claims Manager in updating and maintaining standard operating procedures (SOPs) and training documentation.
• Analyze claims trends, identify root causes of processing errors, and recommend workflow improvements.
• Coordinate with internal teams (Eligibility, Client Services, Accounting) to resolve cross-functional issues.
• Manage specialized tasks such as high-dollar claims review, provider dispute resolution, or out-of-network pricing strategies.
• Support and generate weekly, monthly, and ad hoc claims reporting.
• Maintain expert-level knowledge of HealthPac and payer requirements.
• Perform all duties of a Claims Analyst II when needed.

This description is not meant to be all-inclusive and may be modified from time to time at the discretion of management.

REQUIRED EDUCATION AND EXPERIENCE:

• High School Diploma or equivalent
• Minimum 4 years of experience in medical claims adjudication
• Minimum 3 years of HealthPac system use
• Demonstrated experience working with Reference Based Pricing (RBP), QPA, and complex claims scenarios

PREFERRED EDUCATION AND EXPERIENCE:

• 5+ years of medical claims experience, with increasing levels of responsibility
• Previous experience in a lead or trainer role within a claims department

KNOWLEDGE, SKILLS, AND ABILITIES:

• Expert-level proficiency in HealthPac
• Strong understanding of medical billing, coding, and adjudication processes
• Proven ability to train, guide, and mentor peers
• Advanced Excel and reporting skills
• Exceptional attention to detail and organizational abilities
• Excellent verbal and written communication skills
• Ability to handle sensitive information with confidentiality
• Strong problem-solving skills and ability to think critically under pressure
• Able to work independently while coordinating with multiple departments

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

Job Type: Full-time

Pay: $ $35.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Remote