Audit, review, and adjust medical, dental, and flexible spending accounts and Health Reimbursement Account claims.
Review, apply and create refund letters for all lines of business to members and providers.
Reprocess payments when necessary.
Communicate with members, providers, employer group contacts, and other inquirers pertaining to specific refund questions.
Review plan documents for various groups to research and resolve claim processing questions and issues.
Act with urgency to respond to inquiries regarding refund request status-including research and resolution regarding outstanding request.
Perform other related duties, as assigned.

6 months’ experience in healthcare or insurance industry with respect to operations support, including provider maintenance, billing, coding, or customer support.
Experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.
Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.
Strong interpersonal skills with excellent verbal and written communication skills.
Basic keyboard and Windows based computer skills required.
Familiarity with Microsoft Excel.
Eager to learn the TPA industry and new concepts and processes.

Fantastic medical, dental, and vision insurance*
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company provided Basic Life and AD&D
Company paid Short-Term and Long-Term Disability**
Flexible Spending Accounts*
401(k) Retirement Plan with up to a 6% employer-match**
WOW! (100% fully vested after 3 years)
10+ paid holidays
Generous paid vacation and sick time
Annual Volunteer Paid Day
Annual Tuition Reimbursement
Annual Health and Wellness Reimbursement
Lots of fun company events

Healthcare Claims Specialist

Key skills