Claims and Benefits Specialist

Job Summary

A company is looking for a Claims & Benefits Specialist I.

Key Responsibilities

• Resolve complex claim, benefit, and eligibility issues by coordinating with health plan partners and utilizing internal resources
• Educate and support Care Advocates on claims and benefit questions, enhancing their understanding and training
• Manage an ongoing portfolio of claims/benefits issues, ensuring timely and accurate resolutions in line with client expectations

Required Qualifications

• High School Diploma/GED
• 3+ years of health plan or third-party payor claims processing experience
• 2+ years of experience with medical benefits and claims from either provider or payor perspective
• 2+ years of working knowledge of various lines of business and applicable coding (CPT, HCPCS, ICD-9/10, DRG, etc.)
• Skilled in verbal and written communication