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 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