Claims Specialist

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

📋 Description

• Examine billing inconsistencies, pinpoint errors, and facilitate resolutions among members, carriers, and providers.

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

• Educate members regarding benefit plans and coverage specifics.

• Comply with internal policies, procedures, and federal regulations while processing claims.

• Collaborate with colleagues and escalate unresolved matters to supervisors or carriers.

• Mentor new team members and share effective practices.

• Participate in ongoing process enhancement initiatives.

• Record and monitor cases using internal databases.

⛳️ Requirements

• A minimum of 2 years of experience in healthcare, customer service, or claims processing.

• Proven experience in analyzing claims, identifying root causes, and suggesting feasible solutions.

• Excellent listening skills with the capacity to assist members with empathy and patience.

• Knowledge of plan documents, ACA guidelines, Medicare, COBRA, dental, vision, and behavioral health is advantageous.

• Proficient in MS Word and Excel.

• Comfortable utilizing internal databases for documenting and tracking cases.

• A private, HIPAA-compliant workspace ensuring confidentiality of information.

• Adequate desk space for a dual-monitor setup and related equipment.

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

• Ability to maintain a professional, distraction-free environment during scheduled hours.

• Strong focus and attention to detail.

• Critical thinking and problem-solving abilities.

• Proficient verbal and written communication skills.

🏝️ Benefits

• Extensive medical, dental, and vision insurance.

• 401(k) plan with company matching.

• Paid time off (PTO).

• Thorough training programs.

• Supportive team collaboration.

• Provision of computer equipment, monitors, and other required technology.

• Competitive salary.

• Opportunities for mentoring and involvement in ongoing process improvements.