Claims Specialist

Job Summary

A company is looking for a Claims Specialist who will advocate for members and resolve complex claims issues.

Key Responsibilities

• Resolve complex claims issues by investigating billing discrepancies and coordinating resolutions
• Coordinate benefits across various carriers, including Medicaid and Medicare
• Educate and empower members about their benefit plans and claims processes

Required Qualifications

• At least 2 years of experience in healthcare, customer service, or claims
• Familiarity with plan documents, ACA guidelines, and various benefit programs
• Proficiency in MS Word and Excel
• Ability to analyze claims and identify root causes
• Experience mentoring team members and contributing to process improvements