Employee Benefits Claims Coordinator

Job Description

Job Description

Job Title: Employee Benefits Claims Coordinator

Classification: Non-Exempt

Department: Employee Benefits

Location: Hybrid/Torrance, CA or Schaumburg, IL

Reports to: Customer Service Manager

Overview

Under the direction of the Customer Service Manager, the Employee Benefits Claims Coordinator provides claims support and advocacy for clients and their employees. The Claims Coordinator works closely with the Customer Service Manager, Account Management Team, insurance carriers, providers, and employees to research and assist with the resolution of benefit claim issues.

This is an entry-level position designed for an individual interested in developing a career in the employee benefits and insurance industry. The Claims Coordinator will receive training on employee benefit plans, insurance terminology, carrier processes, and claims procedures.

The Claims Coordinator serves as a centralized resource for claim-related inquiries and escalations, providing timely follow-up, clear communication, and high-quality customer service throughout the resolution process.

Essential Duties & Functions

Other duties may be assigned.

• Acts as a liaison between employees, insurance carriers, healthcare providers, and the Account Management Team to assist with the resolution of benefit claim issues.
• Researches claim inquiries and works with insurance carriers and other parties to identify the cause of claim processing issues and appropriate next steps.
• Assists employees with understanding Explanation of Benefits (EOB) statements, claim status, carrier requests for additional information, and other claim-related communications.
• Assists with denied, incorrectly processed, or outstanding medical, prescription drug, dental, vision, life, and disability claims.
• Assists employees with pre-authorization and prior authorization issues, including communicating with insurance carriers and healthcare providers to determine requirements, status, and next steps.
• Assists employees with benefit and coverage inquiries by reviewing available plan information and working with insurance carriers to confirm applicable benefits, limitations, and requirements.
• Works with insurance carriers to escalate claim issues when additional review or intervention is necessary.