Senior Claims Benefit Specialist

Job Summary

A company is looking for a Senior Claims Benefit Specialist - Remote.

Key Responsibilities

• Reviews and adjudicates complex claims according to processing guidelines
• Handles customer service inquiries related to pre-approval, reconsiderations, or appeals
• Trains and mentors junior claim benefit specialists while ensuring compliance requirements are met

Required Qualifications

• 2+ years of medical claim processing experience
• 1-2 years of experience in a production/metrics-based environment
• High School Diploma required; preferred Associates degree or equivalent work experience
• Demonstrated ability to manage multiple assignments efficiently
• Self-funding experience and DG system knowledge are preferred