Claims Specialist

LanguageLine Solutions

8d•Remote

About The Position

At Health Advocate, we’re on a mission to simplify healthcare and empower our members to navigate their benefits confidently. If you’re ready to make a meaningful impact by resolving complex claims and advocating for those who need support, this is your chance to transform lives. As a Claims Specialist, you’ll go beyond solving billing issues—you’ll serve as an advocate, educator, and problem-solver for our members. By leveraging your expertise in claims, benefits, and coordination of care, you’ll ensure timely resolutions that ease stress and deliver value. In this role, you’ll join a team that values collaboration, precision, and compassion.

Requirements

At least 2 years of experience in healthcare, customer service, or claims.
Proficient in MS Word and Excel and comfortable using internal databases to document and track cases.
A private, HIPAA-compliant workspace where confidential member information cannot be viewed or overheard by others.
Sufficient desk space to accommodate a dual-monitor workstation and related equipment.
Reliable high-speed internet with a minimum download speed of 200 Mbps.
The ability to work in a professional, distraction-free environment during scheduled work hours.

Nice To Haves

Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus.
Passionate about helping others, thrives on solving challenges, and brings technical expertise to the table.
Strong listening skills and the ability to guide members with care and patience, even in complex or emotionally charged situations.

Responsibilities

Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing.
Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination.
Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios.
Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner.
Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary.
Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements.