As a full-time remote Claims Specialist, the successful candidate will resolve complex claims issues, coordinate benefits across carriers, and educate members about their benefit plans while advocating for their needs.
Key responsibilities
Resolve complex claims issues by investigating billing discrepancies and coordinating resolutions among members, carriers, and providers Manage cases involving various benefit programs, ensuring proper coordination of benefits across Medicaid, Medicare, and motor vehicle claims Educate members on their benefit plans and guide them through challenging claims scenarios to empower their understanding Required qualifications At least 2 years of experience in healthcare, customer service, or claims Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and various benefit types Proficiency in MS Word and Excel, with comfort using internal databases Strong analytical skills for identifying root causes of claims issues Ability to maintain a private, HIPAA-compliant workspace for confidential member information
Experience: 2 years required