Claims Specialist

Job Summary

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

Key responsibilities:

• Investigate and resolve billing discrepancies, coordinating with members, carriers, and providers for timely claim processing
• 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, and various benefits such as dental and vision
• Proficiency in MS Word and Excel, with the ability to use internal databases effectively
• Strong analytical skills for identifying root causes of claims issues and proposing solutions
• Ability to maintain a HIPAA-compliant workspace and manage confidential information securely