Healthcare Claims Specialist

Job Description

Job Title : Transaction Processor Associate II (Healthcare Claims Specialist)

Location : Onsite, East Hartford, CT

Employment Type : Full-Time | Monday – Friday (with occasional overtime) No weekends

Position Overview

The Transaction Processing II - Healthcare Claims Specialist plays a key role in supporting transaction processing projects by researching, analyzing, and updating consumer information across multiple systems. This position requires strong attention to detail, organizational skills, and a positive approach to meeting deadlines in a fast-paced environment.

Primary Responsibilities

• Process case maintenance transactions accurately and efficiently within established procedural guidelines.
• Evaluate and determine eligibility of medical expenses for specific programs.
• Communicate professionally with clients and consumers via phone, email, and written correspondence.
• Enter and update consumer information into eligibility determination systems with accuracy.
• Consistently meet or exceed daily productivity and quality standards as defined in the Quality Assurance Plan (QAP).
• Provide excellent customer service, maintaining professionalism with all internal and external partners.
• Maintain working knowledge of procedures, guidelines, and operating systems required for daily tasks.
• Ensure timely completion of assignments in compliance with contractual requirements.
• Exhibit reliability, punctuality, and a positive attitude towards all assigned tasks.
• Adhere to attendance policies and contribute to a positive team environment.

Qualifications

Education & Experience :

Required Skills & Abilities :

Work Environment

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

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