Claims Specialist

Job Summary

Advocating for members and resolving complex claims issues, the full-time remote Claims Specialist will investigate billing discrepancies, coordinate benefits across carriers, and educate members on their coverage while ensuring timely claim processing.

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 across Medicaid, Medicare, and motor vehicle claims
• 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, COBRA, and various benefits
• Proficiency in MS Word and Excel, with comfort in using internal databases
• Strong analytical skills for identifying root causes and proposing practical solutions
• Ability to maintain a private, HIPAA-compliant workspace and reliable high-speed internet