Claims Specialist

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

📋 Description

• Address Complex Claims Issues: Investigate billing discrepancies, pinpoint errors, and facilitate resolutions among members, carriers, and providers to ensure prompt claim processing.

• Manage Benefits Across Carriers: Oversee cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, guaranteeing proper coordination.

• Educate and Empower Members: Assist members in understanding their benefit plans, inform them about coverage details, and guide them through difficult claims situations.

• Ensure Accuracy: Comply with internal policies, procedures, and federal regulations to process claims accurately and in a timely fashion.

• Collaborate and Escalate: Work closely with team members and escalate unresolved issues to supervisors or carriers as needed.

• Foster Team Development: Mentor new team members, share best practices, and contribute to ongoing process enhancements.

⛳️ Requirements

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

• Problem-Solver: You have a talent for analyzing claims, identifying root issues, and suggesting effective solutions.

• Empathetic Communicator: You demonstrate strong listening abilities and can guide members with compassion and patience, even in complex or emotionally charged circumstances.

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

• Tech-Savvy: You are skilled in MS Word and Excel and comfortable navigating internal databases for documenting and tracking cases.

🏝️ Benefits

• Competitive pay: Hourly pay rate starting at $20 per hour.

• Comprehensive Benefits: Enjoy competitive pay, extensive medical, dental, and vision coverage, 401(k) with company match, PTO, and more.

• Tools for Success: Gain access to advanced systems, thorough training, and the support of a collaborative team.

• A Culture of Care: Be part of a team that prioritizes empathy, innovation, and collaboration.