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Senior Claims Analyst
at Amalgamated Life Insurance Company
White Plains, NY

Senior Claims Analyst
at Amalgamated Life Insurance Company
White Plains, NY

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Job Description

 The Senior Claims Analyst is responsible for handling complex claims and all adjustment types, including check maintenance functions, JAA adjustments, and is responsible for providing  claims technical and analytical support to the claims department.  


  • Handle and process all claim and benefit types for all groups/plans  requiring detailed analysis for coverage and claim determination. 
  • Accurately handle and process all claim adjustment types, maintaining timely turnaround.
  • Review and research complex claims, provide necessary feedback to other analysts, and/or complete the handling.
  • Review  customer service and service executive referrals for root cause issues, document and bring to resolution.
  • Review correspondence as assigned and bring to resolution.
  • Understand the Anthem JAA product and workflow, handle and monitor JAA adjustments,  resolve 837 claim failures and assist with aged inventory review.
  • Manage and respond to Anthem JAA customer service mailbox/inquiries, taking appropriate steps to resolve and follow up within required timeframes.
  • Troubleshoot any referred cases, including contact with AMM or other UR vendor, provider relations, Anthem,  and any other required inter-departmental and external personnel.  
  • Perform necessary investigations, including COB, No-fault, pre-existing, subrogation.
  • Utilize training and on-line documentation to keep up to date on processing & adjustment guidelines, insurance principles, DOL rules and regulations, and benefit plan rules.
  • Identify overpayments, perform claim system transactions, send letters, and record recoveries in appropriate database.  
  • Manage the monthly check maintenance functions, including  refunds, voids, stale date review, Anthem voids,  and complete the necessary transactions.
  • Update claims system with applicable claim/and patient notes.
  • Assist with QA of claims and any other assigned projects, as needed.
  • Contact employers, providers, members as needed to bring case to resolution.
  • Utilize workflow to manage work and maintain daily production document. 
  • Handle other claim-related duties, projects and assignments, as assigned.  
  • Job Requirements
  • One to two years of college or equivalent experience.
  • Minimum of three (3) or more years experience as a specialist analyst or five (5) or  more years experience as a production analyst, meeting production and quality  goals/ standards. 
  • Current experience processing medical and hospital claims on Eldorado Claims system.
  • Requires NYS Accident & Health Adjuster License.  
  • Knowledge of insurance and medical claim terminology.
  • High level of keyboard/PC skills.
  • Excellent oral and written communication skills.
  • Good judgment and decision- making abilities.
  • Good analytical and math skills.
  • Good interpersonal skills and willingness to assist others.
  • Basic knowledge of Word and Excel.

Company Description

Amalgamated Life Insurance Company

Founded in 1943, Amalgamated Life Insurance Company is now recognized as one of the nation's leading providers of high quality life, health and worksite/voluntary insurance solutions. The Company's high quality claims management and fiscal stability have earned it over 40 consecutive A.M. Best "A" (Excellent) ratings since 1975, as well as six consecutive placements on the "Ward's 50" list of the nation's top performing insurance companies. Headquartered in White Plains, NY, Amalgamated Life is an employee-centered organization with a robust, highly-competitive employee benefits and compensation package. Employees enjoy a pleasant, modern workplace environment, which features state-of-the-art technology, onsite café and fitness facilities. The Company sponsors many nonprofit and charitable endeavors and supports its employees' participation in these worthwhile causes. Amalgamated Life is a member of the Amalgamated Family of Companies.


Amalgamated Life takes pride in the competitive and extensive benefit programs that are offered to our full-time employees. Amalgamated Life's benefits package includes: Health and Dental Insurance
Optical Coverage
Disability Coverage: Short-Term ; Long-Term Plans
Life Insurance Coverage
Pension Plan
401(k) Plan
Fidelity Goal Planner After-Tax Savings Plan
Flexible Spending Accounts for Health Care and Dependent Care
Tuition Reimbursement
Fitness Gym Membership Discounts
e-TRAC (New York)
Time off Benefits: Vacation, Sick
Days, Personal Days, Holidays
Opt-Out Reimbursement Program
Employee Referral Award Program

This Employer Participates in E-Verify. See the E-Verify notices. Este Empleador Participaen E-Verify. Ver el E-Verify avisos.

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