Claim Benefit Specialist

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Evaluate and adjudicate claims in line with claim processing protocols.

• Implement medical necessity criteria and assess coverage.

• Conduct eligibility verification and spot discrepancies.

• Enforce cost containment strategies during the claims adjudication process.

• Review claims or referral submissions, applying relevant guidelines, coding, member identification, provider selection, and pre-coding standards.

• Analyze and authorize rework claims that are unable to be auto-adjudicated.

• Oversee claims on desk, routes/queues, and ECHS within designated turnaround-time parameters.

• Utilize relevant system functions, including Claim Check, reasonable and customary data, along with other post-containment tools.

• Guarantee precise and timely claim processing services.

⛳️ Requirements

• 1–2 years of experience in Customer Service.

• Strong collaboration and organizational abilities.

• Excellent and effective communication skills.

• Capability to manage multiple assignments competently through effective time management.

• Ability to work with accuracy and efficiency.

• Experience in a production environment (preferred).

• Background in healthcare (preferred).

• Familiarity with utilizing various systems simultaneously to resolve complex issues (preferred).

• Claim processing experience (preferred but not mandatory).

• Understanding of medical terminology (preferred).

• High School diploma, GED, or equivalent experience.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources promoting physical, emotional, and financial well-being, based on eligibility.