Senior Claims Analyst

Job Description

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

Pay Details:

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Why Join Us:

At Acrisure, we’re building more than a business, we’re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.

Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• … and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome, your new opportunity awaits you.