Claims Coordinator

Reports To: Enterprise Applications & Data Integration Specialist

About the Company

At New Health Partners, our mission is to equip insurance agents with the tools, resources, and opportunities to thrive. As health insurance advocates, we provide expert guidance and support, ensuring you have the confidence and knowledge to offer your clients the best options. With a powerful portfolio of products, expert marketing support, innovative technology, and a dedicated learning center, we empower you to grow your business and reach new heights of success — every step of the way.

Position Overview

We are seeking a motivated and dependable professional to join our team. Candidates of all experience levels are welcome and encouraged to apply, including entry-level and experienced professionals. This position is ideal for someone who is organized, detail-oriented, and comfortable working in a professional office environment while supporting both our internal team and the agencies and agents we work with.

The Claims Coordinator provides administrative and operational support in managing and coordinating insurance claims on behalf of the agents and agencies supported by New Health Partners. This position works closely with agents, agencies, insurance carriers, and internal team members to help ensure claims are properly submitted, documented, tracked, and followed through to resolution. This will be a hybrid position.

The position assists with claim submissions, documentation requests, claim status follow-ups, carrier communications, claim issues, escalations, and maintaining accurate claim records. The Claims Coordinator helps ensure that claims are properly organized and that agents and agencies receive timely updates and assistance throughout the claims process.

The position works under the direction of the Claims Manager and assists with day-to-day claims operations while escalating complex claims, unresolved issues, carrier disputes, or matters requiring management involvement.

What You'll Do

The Claims Coordinator serves as a primary point of support for agents and agencies regarding claim-related questions, documentation, and follow-up. The Claims Coordinator works with insurance carriers to obtain claim status, request information, and assist with resolving issues while escalating complex or sensitive matters to the Claims Manager.

In addition to the supporting and escalation responsibilities outlined above, the Claims Coordinator will also:

- Assist agents and agencies with the submission and follow-up of insurance claims.

- Contact agents and agencies to request missing documentation or information needed to process claims.

- Communicate with insurance carriers regarding claim status, required documentation, processing delays, and claim-related questions.

- Track submitted claims and monitor claim status, outstanding information, follow-up dates, and resolutions.

- Collect and organize supporting documentation, including claim forms, medical documentation, bills, receipts, eligibility information, correspondence, and other requested records.

- Review claim submissions for completeness and identify missing or incorrect information requiring follow-up.

- Maintain accurate and organized claim files and records.

- Follow up with carriers on pending, delayed, denied, or unresolved claims as directed.

- Communicate claim updates and carrier responses to the appropriate agents and agencies.

- Assist agents and agencies with understanding the status and next steps associated with their claims.

- Document all claim-related communications, follow-ups, carrier responses, and outcomes.

- Maintain claim trackers and internal databases with accurate claim information and status updates.

- Cross-reference agent, agency, member, policy, and carrier information when necessary to assist with claim research and follow-up.

- Assist with identifying recurring claim issues, processing delays, or carrier-related concerns and escalate trends to the Claims Manager.

- Assist with researching denied or disputed claims and gathering information needed for further review or escalation.

- Monitor outstanding claims and follow up within established timeframes to help prevent unnecessary delays.

- Prepare routine claim-related correspondence and follow-up communications.

- Maintain organized records of claim resolutions, denials, appeals, carrier responses, and other claim outcomes.

- Assist with preparing periodic claims reports and summaries for management.

- Support internal reviews by gathering, organizing, and validating requested claim documentation.

- Assist with maintaining claims procedures, templates, forms, reference materials, and other departmental resources.

- Perform routine research and administrative tasks related to health insurance claims, carrier requirements, and claim procedures as directed by the Claims Manager.

- Provide general operational support to the Claims Department and perform other claims-related duties as assigned.

What We're Looking For

- Bilingual proficiency in English and Spanish - Required

- Ability to work both remotely and in the office - Required

- Strong organizational and time-management skills - Required

- Excellent attention to detail and accuracy - Required

- Strong written and verbal communication skills - Required

- Ability to communicate professionally with agents, agencies, insurance carriers, and internal team members - Required

- Ability to handle confidential information professionally - Required

- Ability to manage multiple claims, deadlines, and follow-up items in an organized manner - Required

- Comfort working independently while also collaborating with the Claims Manager and other members of the team - Required

- Proficiency with Microsoft Office and general computer applications - Required

- Willingness to learn health insurance claims processes, carrier requirements, and applicable procedures - Required

Previous experience in claims, health insurance, Medicare, ACA/Marketplace, an insurance agency, carrier, FMO, or working directly with insurance agents and agencies - Preferred

Schedule

Monday–Friday

9:00 AM - 5:00 PM (Eastern)

Weekends Off

Benefits

- 401(k) Retirement Plan — Traditional and Roth

- Health benefits package

- Paid time off & holidays

- Career growth opportunities