Claims Specialist

A company is looking for a Claims Specialist to resolve complex claims and advocate for members navigating their healthcare benefits.

Key Responsibilities

Resolve complex claims issues by investigating billing discrepancies and coordinating resolutions

Coordinate benefits across various carriers, including Medicaid and Medicare

Educate and empower members on their benefit plans and claims processes

Required Qualifications

At least 2 years of experience in healthcare, customer service, or claims

Familiarity with plan documents, ACA guidelines, and various benefit programs

Proficiency in MS Word and Excel, with comfort in using internal databases

Ability to analyze claims and propose practical solutions

Strong listening skills to guide members through complex situations