Claims Specialist

Job Summary

To support the management of Catastrophic Health Plans, the full-time hourly Claims Specialist will coordinate the tracking, monitoring, documenting, and submission of catastrophic claims while working remotely.

Key responsibilities

• Compile and submit stop loss claims to the carrier for reimbursement and manage large case notifications
• Ensure accurate and timely reporting and documentation in alignment with internal standards and regulatory requirements
• Provide exceptional customer service by following up with internal and external customers and escalating issues as necessary

Required qualifications

• High School Diploma or GED
• 2-3 years of experience in medical claims administration or health insurance operations
• Experience working with self-funded medical plans and understanding stop loss concepts
• Familiarity with supporting documents such as EOBs and claims extracts
• Proficient in using Microsoft Office products