Healthcare Claims Specialist

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

📋 Description

• Conduct audits, reviews, and adjustments of medical, dental, flexible spending accounts, and Health Reimbursement Account claims.

• Create and apply refund letters for all lines of business directed to members and providers.

• Reprocess payments when deemed necessary.

• Interact with members, providers, employer group contacts, and other inquiries regarding specific refund-related questions.

• Examine plan documents for various groups to investigate and resolve claim processing inquiries and issues.

• Act promptly to address inquiries concerning the status of refund requests, including research and resolution of outstanding requests.

• Carry out other related responsibilities as assigned.

⛳️ Requirements

• A minimum of 6 months’ experience in the healthcare or insurance sector focusing on operations support, which includes provider maintenance, billing, coding, or customer support.

• Previous experience in healthcare billing or a background with a health insurance carrier or Third-Party Administrator is highly preferred.

• Strong time-management abilities, capable of prioritizing multiple tasks while maintaining a sense of urgency.

• Excellent interpersonal skills complemented by strong verbal and written communication capabilities.

• Basic keyboard proficiency and familiarity with Windows-based computer systems are required.

• Knowledge of Microsoft Excel is advantageous.

• A desire to learn about the TPA industry along with new concepts and processes.

🏝️ Benefits

• Exceptional medical, dental, and vision insurance*

• Biannual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!

• Company-sponsored Basic Life and AD&D insurance

• Company-funded Short-Term and Long-Term Disability benefits**

• Flexible Spending Accounts*

• 401(k) Retirement Plan with up to a 6% employer match**

• WOW! (100% fully vested after 3 years)

• Over 10 paid holidays

• Generous paid vacation and sick leave

• Annual Volunteer Paid Day

• Annual Tuition Reimbursement

• Annual Health and Wellness Reimbursement

• Numerous engaging company events