Claim Benefit Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Examine claim documentation and verify coverage under the policy.

• Evaluate the validity of claims, medical necessity, coding compliance, and documentation requirements.

• Engage in communication with healthcare providers and policyholders.

• Accurately and efficiently manage and process claims submitted by healthcare providers.

• Ascertain benefit eligibility and coverage according to insurance plans and policy guidelines.

• Record claim information, codes, modifiers, and data elements in the company’s system.

• Perform claim reviews and investigations that necessitate further scrutiny or validation.

• Ensure that claims processing adheres to regulatory requirements, industry standards, and company policies.

• Achieve performance metrics related to production, quality, and turnaround time.

⛳️ Requirements

• Minimum of 1 year of experience in claims, call center, or a similar customer service role within Healthcare.

• Proficient in computer operations and software applications.

• Experience working in a production environment.

• Capability to meet performance metrics for production, quality, and turnaround time.

• Strong skills in teamwork and organization.

• High School diploma or equivalent GED is required.

• Must be available for a 21-week training period.

• Applicants should reside in the Central, Mountain, or Pacific Standard Time Zone.

🏝️ 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.