Claims Analyst

SummaCare \- 1200 E Market St, Akron, OHFull\-Time / 40 Hours / DaysRemote opportunity Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4\.5 out of 5\-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.Summary : Reviews and analyzes claims processing work completed by Claims and Recovery staff before and after the actual payment of claims, to ensure quality, accuracy and compliance with department processing guidelines. Educational Requirements Associate Degree, or may substitute with 2 year like experience. Required Experience 2\+ years performing same or similar responsibilities. Relevant experience includes: health plan medical claims auditing, claims processing at a senior, specialist or team lead level, and/or quality assurance auditing of claims. Required Licenses and/or Certificates None required. Software and Data Entry Requirement 1\. Word at an intermediate level. 2\. Excel at an intermediate level. 3\. Access at an intermediate level. SKILLS AND ABILITIES Communication High: ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day\-to\-day departmental operations; ability to interface with internal staff, mid\-upper management professionals, and general public. Analytical High: collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department. Proofreading completed work to find and correct errors. Requires excellent attention to detail. Other Knowledge, Skills and Abilities 1\. Remain current with business rules specific to assigned areas of review, including manual processes. 2\. Maintains working knowledge of Amisys benefit, pricing, configuration, and adjudication processes. 3\. Learn new software programs and systems including basic understanding of SQL. 4\. Display understanding of the intent of the business process being reviewed. 5\. Effectively work in an autonomous manner, while meeting department goals, objectives, and deadlines. 6\. Demonstrate excellent attention to detail. 7\. Apply principles of logical thinking to define problems, collect data, establish facts and draw valid conclusions. 8\. Organize and manage time to accurately complete tasks within designated time frames in fast\-paced environment. 9\. Maintain current knowledge of and comply with regulatory and company policies \& procedures. 10\. Maintain confidentiality of member health information and business information. 11\. Flexible: ability to adjust work hours to meet business demands. Physical Effort and Dexterity\ 1\. Sit for prolonged periods of time. 2\. Lift up to 20 pounds. 3\. Manual dexterity to operate computer, phone, and standard office machines. Visual Acuity, Hearing, and Speaking\ Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform essential functions of job with reasonable accommodation. Scheduling Occasional overtime work required during peak business periods as scheduled by supervisor. Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars. Safety Hazards and Environment Minimal hazards. General office working conditions. Equal Opportunity Employer/Veterans/Disabled $21\.54/hr \- $25\.86/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. Basic Life and Accidental Death \& Dismemberment (AD\&D) Supplemental Life and AD\&D Dependent Life Insurance Short\-Term and Long\-Term Disability Accident Insurance, Hospital Indemnity, and Critical Illness Retirement Savings Plan Flexible Spending Accounts – Healthcare and Dependent Care Employee Assistance Program (EAP) Identity Theft Protection Pet Insurance Education Assistance * Daily Pay