Claims Specialist

Job Summary

To support a mission of simplifying healthcare, the full-time remote Claims Specialist will resolve complex claims issues, coordinate benefits across various carriers, and educate members about their benefit plans while advocating for their needs.

Key responsibilities

• Investigate and resolve billing discrepancies, ensuring timely claim processing
• Manage cases involving Medicaid, Medicare, and other benefit programs for proper coordination
• Guide members through their benefit plans and challenging claims scenarios

Required qualifications

• At least 2 years of experience in healthcare, customer service, or claims
• Strong analytical skills for identifying root causes of claims issues
• Familiarity with plan documents, ACA guidelines, and various benefits
• Proficiency in MS Word and Excel, with comfort in using internal databases
• Ability to maintain a HIPAA-compliant workspace for confidential member information