Claims Operations Specialist

Job Summary

Working remotely or in a hybrid capacity, the full-time Claims Operations Specialist will review and resolve claims-related items, correspond with providers and members, and identify process improvement opportunities to ensure accurate and timely claims processing.

Key responsibilities

• Review and resolve various claims-related items and reports, including complex cases, using the claims processing system
• Correspond with providers, members, and internal partners to gather necessary information for timely claim adjudication
• Identify trends and opportunities for process improvements, including updates to the Claims Manual

Required qualifications

• High school diploma or equivalency
• 3+ years of experience in medical or dental claims processing
• Strong computer skills, including familiarity with Microsoft Office products and Microsoft Windows operating systems
• Proven attention to detail and commitment to continuous quality improvement
• Ability to complete tasks under short deadlines with timely follow-up on work assignments