Senior Claims Benefit Specialist

Job Summary

Reviewing and adjudicating complex medical claims, the full-time Senior Claims Benefit Specialist will serve as a subject matter expert, providing coaching and support to ensure a positive member experience while working remotely.

Key responsibilities

• Adjudicates complex claims in accordance with established guidelines and verifies eligibility
• Applies medical necessity guidelines and implements cost containment measures to support accurate claim processing
• Trains and mentors team members to enhance performance and technical proficiency

Required qualifications

• Minimum of 18 months of medical claim processing experience with a health insurance payor or third-party administrator
• Proven success in a high-volume, production-driven environment
• Demonstrated ability to manage multiple assignments with accuracy and efficiency
• High School Diploma required; preferred Associates degree or equivalent work experience