Claims Operations Specialist

Job Summary

To support accurate and timely claims processing, the full-time Claims Operations Specialist will review and resolve various claims-related items, collaborate with providers and members, and identify opportunities for process improvements in a remote or hybrid work environment.

Key responsibilities

• Review and resolve a variety of claims-related items and reports, including complex cases, using the claims processing system
• Correspond with providers, members, and internal partners to gather information needed for timely claims 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
• Ability to complete tasks on short deadlines while ensuring timely follow-up on work assignments
• Strong attention to detail and commitment to continuous quality improvement