Claims Eligibility Specialist I

Continental General • Austin, TX

1d • $55,000 - $65,000 • Hybrid

About The Position

As a Claims Eligibility Specialist I, you will play a critical role in reviewing and managing claims of varying complexity. You’ll work closely with a collaborative team, supporting the accurate and timely processing of claims while ensuring a high-quality customer experience. This is a great opportunity for someone with a strong background in claims and a desire to grow in a fast-paced, mission-driven environment.

Requirements

• High school diploma or equivalent
• 1-3 years of related experience
• Possesses technical knowledge and skills related to claims management and review
• Communicates effectively, both orally and in writing, with empathy and strong listening skills

Responsibilities

• Investigates and maintains simple complexity claims, including but not limited to:
• Reviews and evaluates coverage and / or liability.
• Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions.
• Establishes appropriate Plan of Care according to Claim Handling Guidelines
• Accurately documents claim record with eligibility details.
• Conveys simple claim details (coverage, decisions, expectations, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
• Ensures claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
• Performs other duties as assigned.

Benefits

• Competitive Salary & Target Bonus Program
• Retirement Savings – 401(k) with a company match
• Comprehensive Medical insurance through BlueCross BlueShield of Texas.
• Company-paid dental, vision, short-term & long-term disability, and life insurance.
• Work-Life Balance – 20 days of PTO, 10 paid holidays, and paid volunteer time off.
• Flexible Work Options & Perks – Hybrid and remote opportunities, wellness programs, and weekly paid lunch for onsite staff.
• Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs.

What This Job Offers

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