Claims Specialist

A company is looking for a Claims Specialist responsible for managing escalated and complex claims cases in a timely manner.

Key Responsibilities

Handle escalated and complex claims cases, ensuring timely resolution by collaborating with plan documents, carriers, providers, and members

Research and resolve benefit claims issues, billing discrepancies, and coding errors while educating members on their benefit plan coverage

Assist with the claims adjudication process and ensure compliance with established policies, procedures, and federal regulations

Required Qualifications

High School Degree or GED required; Associate degree in a related field preferred

Minimum of two years of customer service, healthcare, or claims experience required

Basic knowledge of MS Word and Excel required

Ability to pass standardized testing and interviews

Bilingual skills may be required based on program needs