Claims Specialist

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

📋 Description

• Investigate discrepancies in billing, pinpoint errors, and facilitate resolutions among members, carriers, and providers.

• Handle cases related to Medicaid, Medicare, motor vehicle claims, and various benefit programs.

• Provide education to members regarding benefit plans and coverage specifics.

• Accurately and promptly process claims in accordance with internal policies, procedures, and federal regulations.

• Work collaboratively with team members and escalate unresolved issues to supervisors or carriers.

• Mentor new team members and share effective practices.

• Participate in ongoing process improvements.

• Document and monitor cases using internal databases.

• Advocate for members and assist in simplifying the navigation of healthcare.

⛳️ Requirements

• Minimum of 2 years of experience in healthcare, customer service, or claims.

• Proven experience in analyzing claims, identifying root causes, and recommending practical solutions.

• Excellent listening abilities with the capacity to guide members with compassion and patience.

• Familiarity with plan documents, ACA guidelines, Medicare, COBRA, dental, vision, and behavioral health benefits is advantageous.

• Proficient in MS Word and Excel.

• Comfortable utilizing internal databases for documenting and tracking cases.

• A private, HIPAA-compliant workspace where confidential information remains secure from view or overhearing.

• Adequate desk space for a dual-monitor workstation and associated equipment.

• Reliable high-speed internet connection with a minimum download speed of 200 Mbps.

• A professional, distraction-free work environment during scheduled hours.

• Strong focus, attention to detail, critical thinking, and problem-solving capabilities.

• Effective verbal and written communication skills.

• Ability to engage in prolonged sitting, extensive computer usage, frequent phone communication, as well as fingering, grasping, pulling hand-over-hand, and performing repetitive motions.

🏝️ Benefits

• Comprehensive training and support.

• Opportunities for career advancement and internal promotions.

• Competitive compensation starting at $18.00 per hour.

• Coverage for medical, dental, and vision.

• 401(k) plan with company match.

• Paid time off (PTO).

• Health Advocate-provided computer equipment, monitors, and necessary technology.

• Collaborative team atmosphere.

• Purpose-driven work that supports members.

• Access to advanced systems and thorough training.