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 on their benefit plans.

Key responsibilities

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

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, with comfort using internal databases
• Strong analytical skills to identify root causes of claims issues
• Ability to maintain a HIPAA-compliant workspace for handling sensitive information