Claim Benefit Specialist

This is a fully remote position, open to applicants in Alabama, +44 more states.

📋 Description

• Evaluate and amend intricate, sensitive medical and hospital claims as part of the rework project department.

• Collaborate closely with members of the Commercial Services Operations team to conduct root cause analysis and accurately resolve impacted claims.

• Ensure that rework project claims are resolved correctly and completed by the designated due date.

• Act as a medical/hospital claim processor for rework projects, compliance matters, and complex issues.

• Handle claims for particular providers/networks or large-scale rework initiatives arising from plan sponsor challenges, release fallout, and legal, regulatory, or compliance issues.

• Liaise with relevant areas to address and resolve claims.

⛳️ Requirements

• At least 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a similar healthcare administrative role.

• Strong analytical and problem-solving abilities with the capacity to investigate and resolve complex claim issues.

• Proven capability to juggle multiple priorities while meeting quality and turnaround time standards.

• Keen attention to detail and a strong commitment to accuracy.

• Proficient in Microsoft Excel, including sorting, filtering, and performing basic data analysis.

• Demonstrated ability to thrive in a fast-paced environment while adapting to evolving business needs.

• High School diploma or equivalent.

• Experience in healthcare, insurance, claims processing, medical billing, or customer service roles.

• Familiarity with medical terminology, insurance benefits, or healthcare operations.

• Experience utilizing computer systems to investigate and resolve customer or claim-related issues.

• Ability to work autonomously as well as collaboratively within a team setting.

• Strong organizational and time management skills.

• Demonstrated flexibility and eagerness to learn new processes and systems.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Other resources supporting physical, emotional, and financial well-being, based on eligibility