Claims Specialist

Claims Specialist

We are seeking a meticulous Claims Specialist to uphold our high standards of quality and procedure adherence, ensuring seamless claim processing in accordance with company policies. Your responsibilities will include thorough claim reviews, timely completion of tasks to meet production targets, and meticulous attention to detail in system setup and documentation comprehension. You'll also be tasked with identifying and promptly reporting any discrepancies or issues to management, contributing to the continuous improvement of our processes.

Additionally, you will play a pivotal role in the stop loss renewal process under the guidance of our management team. Your commitment to ongoing training and your ability to enforce company procedures and standards will be essential. Excellent communication skills are a must, as you'll engage with clients, internal teams, and vendors to ensure customer satisfaction and efficient resolution of inquiries.

In addition to your day-to-day responsibilities, you'll have the opportunity to support various projects and special requests, showcasing your versatility and dedication to our team's success. Your performance will be rewarded and recognized in an environment that fosters growth and provides clear direction for advancement.

Requirements

Qualifications:

• High School Diploma required; Associate Degree in Business preferred.
• Minimum of 2 years' experience in claims processing
• Experience in QicLink or Eldorado system preferred or large claims platform
• Proven ability to establish and maintain positive client relationships and deliver exceptional customer service.
• Proficiency in Windows and Microsoft Office Suite, particularly Word, Outlook, and Excel.
• Familiarity with insurance database systems is advantageous.
• Strong teamwork and collaboration skills.
• Preferred experience in the healthcare industry, specifically in healthcare administration, health insurance, or medical office settings.
• Remote work may be considered based on experience and business requirements.