Claims Specialist

Job Summary

As a full-time remote Claims Specialist, the successful candidate will resolve complex claims issues, coordinate benefits across carriers, and educate members about their benefit plans while advocating for their needs.

Key responsibilities

• Resolve complex claims issues by investigating billing discrepancies and coordinating resolutions among members, carriers, and providers
• Manage cases involving various benefit programs, ensuring proper coordination of benefits across Medicaid, Medicare, and motor vehicle claims
• Educate members on their benefit plans and guide them through challenging claims scenarios to empower their understanding

Required qualifications

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