Claims Specialist

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

📋 Description

• Investigate discrepancies in billing and pinpoint errors in claims.

• Facilitate resolutions among members, carriers, and providers to ensure prompt claim processing.

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

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

• Comply 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 best practices within the team.

• Contribute to ongoing process enhancements.

• Record and monitor cases using internal databases.

• Advocate for members as they navigate through healthcare claims and benefits.

⛳️ Requirements

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

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

• Excellent listening skills with the ability to assist members with empathy 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 to log and track cases.

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

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

• Access to reliable high-speed internet with a minimum download speed of 200 Mbps.

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

• Capability to perform prolonged sitting, computer usage, frequent phone interactions, as well as manual dexterity tasks.

• Strong focus, attention to detail, critical thinking, problem-solving abilities, and effective verbal and written communication skills.

🏝️ Benefits

• Comprehensive training and support.

• Opportunities for professional growth and internal promotions.

• Coverage for medical, dental, and vision needs.

• 401(k) plan with company matching contributions.

• Paid Time Off (PTO).

• Provision of computer equipment, monitors, and essential technology.

• Access to advanced systems and thorough training.

• A collaborative team environment.