Claims Specialist

Job Summary

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

Key Responsibilities

• Resolve complex claims issues by investigating billing discrepancies and coordinating resolutions
• Coordinate benefits across various carriers, managing cases involving Medicaid, Medicare, and other programs
• Educate and empower 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, Medicare, and benefits such as dental and vision
• Proficiency in MS Word and Excel, with comfort in using internal databases
• Ability to mentor new team members and contribute to process improvements
• Strong emotional resilience and ability to handle sensitive situations