Claims Relations Coordinator

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

📋 Description

• Oversee and coordinate claims issues reported by providers, members, or other parties through phone calls, emails, and a ticketing system.

• Ensure prompt responses to the provider community regarding the resolution of their concerns.

• Conduct claims research, including reviewing the claims processing system and examining previous/current tickets in the Claims Support Queue.

• Compose communications related to providers and analyze trends in provider-related issues.

• Provide recommendations for necessary updates to the Claims Processing System and Claims Staff training programs.

⛳️ Requirements

• High School diploma/GED with at least six (6) years of experience in managing multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or conducting research in a healthcare or public health environment.

• OR an Associate’s degree with a minimum of four (4) years of experience in a healthcare or public health setting.

• OR a Bachelor’s degree with at least two (2) years of experience in a healthcare or public health context.

• Minimum of six (6) years of in-depth medical claims research experience, including reviewing denials, verifying member eligibility, effectively communicating both in writing and verbally with the provider community, and analyzing claims reports.

• A valid driver’s license is required.

• Must be a resident of North Carolina.

• Ability to travel within the catchment area as needed.

🏝️ Benefits

• Health Insurance with no premium for employee coverage

• Flexible Spending Accounts

• 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year

• NC Local Government Retirement Pension (defined-benefit plan)

• 401k with 5% employer match and immediate vesting

• Public Service Loan Forgiveness (PSLF) qualifying employer

• Quarterly stipend for remote work supplies