Claim Benefit Specialist

This is a fully remote position, open to applicants in Connecticut, +16 more states.

📋 Description

• Evaluate and adjudicate claims in accordance with claim processing guidelines.

• Assess and comprehend coverage under members' health plans.

• Utilize multiple systems and screens to gather and document claim information.

• Analyze claims to ascertain the nature of members' illnesses or injuries.

• Identify opportunities for claim cost management and refer claims for further action.

• Make decisions regarding claim payments.

• Accurately process claims while adhering to quality and production standards.

• Assist team members in achieving team, office, regional, and national objectives.

• Deliver prompt, efficient, and high-quality claim services to improve customer satisfaction and retention.

⛳️ Requirements

• Candidates must reside in the Eastern Time Zone (EST).

• Mandatory attendance during the 21-week training period.

• Experience in a quality and production-focused environment.

• Strong attention to detail.

• Proficiency in using multiple computer applications simultaneously.

• High School Diploma or equivalent GED.

• Comfortable with meeting quality goals, production targets, and service expectations.

• Willingness to work overtime after training based on business requirements.

• Prior experience in medical claim processing is advantageous.

• Outstanding analytical abilities.

• Quick and accurate keyboarding skills.

• Advanced navigation skills in a computer environment, particularly Windows.

• Strong verbal and written communication skills.

• Ability to adapt swiftly and willingly to changes.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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