Claims Specialist

Advocating for members and resolving complex claims issues, the full-time remote Claims Specialist will investigate billing discrepancies, coordinate benefits across carriers, and educate members on their coverage while ensuring timely claim processing. 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 across Medicaid, Medicare, and motor vehicle claims Educate members on their benefit plans and guide them through challenging claims scenarios Required qualifications At least 2 years of experience in healthcare, customer service, or claims Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and various benefits Proficiency in MS Word and Excel, with comfort in using internal databases Strong analytical skills for identifying root causes and proposing practical solutions Ability to maintain a private, HIPAA-compliant workspace and reliable high-speed internet