Claims Specialist

Job Summary

A company is looking for a Claims Specialist to resolve complex claims and advocate for members in navigating their healthcare benefits.

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 on 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, Medicare, and COBRA
• Proficiency in MS Word and Excel
• Strong analytical skills to identify root causes of claims issues
• Ability to mentor new team members and contribute to process improvements