Claims Specialist

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

📋 Description

• Manages the Claims Management inbox, handling incoming calls, mail, and faxes; identifies, prioritizes, and directs requests to the appropriate teams.

• Coordinates and disseminates claims and risk notifications to both internal and external stakeholders promptly.

• Confirms provider insurance coverage and credentials utilizing various databases and systems.

• Prepares, reviews, and maintains claims reporting and assignment documentation in line with established guidelines.

• Keeps accurate internal and external claims files, ensuring that documentation is comprehensive, compliant, and current.

• Conducts monthly reviews of submitted claims to verify accuracy and completeness.

• Aids in insurance coverage verifications and processing invoice-related check requests.

• Assists in data collection and reporting related to claims mitigation objectives and departmental metrics.

• Establishes, updates, and maintains files, databases, records, reports, SOPs, templates, and documentation libraries.

• Works collaboratively with internal teams and external vendors to enhance claims operations.

• Escalates complex, sensitive, or non-routine matters to the appropriate stakeholders in a timely manner.

• Performs other duties as assigned.

⛳️ Requirements

• A High School Degree or GED is mandatory.

• At least 1 year of prior work experience is essential.

• Experience in Property and Casualty Claims or Insurance is preferred.

• Preference will be given to candidates with clinical, healthcare, claims, and/or legal experience.

• Experience with the Origami Risk Information System is preferred.

🏝️ Benefits

• Medical

• Dental

• Vision

• Life

• Disability

• Healthcare FSA

• Dependent Care FSA

• Limited Healthcare FSA

• FSAs for Transportation and Parking

• HSAs

• Paid Time Off

• 9 observed holidays

• Paid family leave