Claims Specialist

Job Summary

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 discrepancies and coordinating resolutions
• Coordinate benefits across various carriers, including Medicaid and Medicare
• Educate members on their benefit plans and guide them through claims scenarios

Required Qualifications

• At least 2 years of experience in healthcare, customer service, or claims
• Familiarity with plan documents, ACA guidelines, and various benefit programs
• Proficient in MS Word and Excel, with comfort in using internal databases
• Strong analytical skills to identify root causes and propose solutions
• Ability to mentor new team members and contribute to process improvements