Claims Specialist II
About The Position
HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. As a Claims Specialist, you’ll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you’ll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members. Your role goes beyond handling claims, you’ll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful.
Requirements
- High school diploma required
- 3-5+ years of claims processing experience
- 2+ years of BCBS claims processing experience
- Strong interpersonal and communication skills
- Strong attention to detail, with high degree of accuracy and urgency
- Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving
- Previous success in a fast-paced environment
Responsibilities
- Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments with precision.
- Manage high-importance claims and vendor billing with urgency and attention to detail.
- Review and reply to appeals, inquiries, and other communications related to claims.
- Work with third-party organizations to secure payments on outstanding balances.
- Process case management and utilization review negotiated claims
- Spot potential subrogation claims and escalate them appropriately.
- Actively contribute to team success by assisting colleagues when workloads peak, sharing knowledge, and fostering a collaborative environment.
Benefits
- Seventeen (IC) days paid time off (individual contributors)
- Eleven paid holidays
- Two paid personal and one paid volunteer day
- Company-subsidized medical, dental, vision, and prescription insurance
- Company-paid disability, life, and AD&D insurances
- Voluntary insurances
- HSA and FSA pre-tax programs
- 401(k)-retirement plan with company match
- Annual $500 wellness incentive and a $600 wellness reimbursement
- Remote work and continuing education reimbursements
- Discount program
- Parental leave
- Up to $1,000 annual charitable giving match
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
101-250 employees
