Claims Coordinator

National Healthcare Solutions, Inc. • Miami, FL

108d

About The Position

The Claims Coordinator handles inquiries and concerns related to claims, including coverage details, benefit limits, explanation of denials, and payment status. This role is responsible for receiving, responding to, and directing phone calls and other communications from members, brokers, and providers—ensuring accurate information is provided promptly and escalating issues when necessary.

Requirements

• High school diploma or equivalent required
• Related experience preferred
• Fluent in English and Spanish
• Strong confidentiality and time management skills
• Ability to learn quickly and work independently with self-motivation

Responsibilities

• Receive and handle customer inquiries from potential, current, and former members, brokers, and providers.
• Provide timely, accurate, and clear information in response to customer requests.
• Process customer requests following established departmental policies and procedures.
• Conduct research and investigations to resolve customer inquiries effectively.
• Collaborate closely with claims adjudicators and other departments to gather necessary information.
• Deliver timely feedback to customers through outbound calls, emails, mail, or fax.
• Identify potential fraudulent claims and take appropriate action in line with company protocols.
• Assist with client office visits as needed.
• Report service failures, systemic issues, and customer concerns promptly to the Claims Director or Claims Manager.
• Generate reports for brokers to facilitate the completion of claims and payment processes.
• Support the completion of special projects as assigned.
• Attend and actively participate in meetings and training sessions as required.
• Perform other duties as assigned.

Benefits

• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Hybrid Work Model (combination of remote and in-office work)
• Wellness Programs, including free access to our building gym
• A vibrant, engaging work environment that values and supports our employees’ growth, well-being, and success

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED