Claims Specialist

Process, review, and adjust routine life or health claims Review, analyze, and process claims, adjustments, coordination of benefits, and refunds Enter codes and data accurately into applicable systems Refer more complex claims to a more experienced specialist Handle final expense or preneed life products Handle Medicare Supplement, Dental, Hospital Indemnity, or related health products Respond to agent, policyholder, and provider inquiries about policy coverage and related information by phone, email, letter, or other channels Cross-train on additional health products Back up medical records, transmittal, provider files, or other related duties Requirements General knowledge of the principles, processes, and practices related to claims processing, including local, state, and government insurance‑related policies Strong verbal and written communication skills Intermediate computer skills with basic knowledge of MS Office Suite (Excel, Word, and PowerPoint) Ability to meet or exceed procedural, financial, quality, production, adjudication, and state and federal compliance metrics Acts in accordance with HIPAA Privacy and Security guidelines High school diploma or GED equivalent Previous related experience is a plus Core Competencies Demonstrates expertise in claims processing, including handling life and health claims, while ensuring compliance with HIPAA guidelines and state and federal regulations. Proficient in data entry and communication with agents, policyholders, and providers regarding policy coverage. Highest-signal resume keywords Claims Processing HIPAA Compliance MS Office Suite Verbal Communication Written Communication Hard Skills Claims Review Data Entry Adjustments Processing Coordination of Benefits Refund Processing Soft Skills Strong Communication Skills Certifications & Qualifications High School Diploma GED Equivalent Industry Keywords Life Insurance Health Insurance Medicare Supplement Dental Products Hospital Indemnity #J-18808-Ljbffr