Claims Specialist

Health Advocate

. Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers .

Posted 10/13/2026full-timeRemote • United StatesJuniorMid-Level💰 $18 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare claims processing, including Medicaid and Medicare, while effectively educating members about benefit plans. Strong analytical skills for identifying discrepancies and proposing solutions, combined with excellent communication and mentoring abilities.

Highest-signal resume keywords

Healthcare Claims ProcessingMedicaid and Medicare ExperienceAnalytical SkillsEffective CommunicationMentoring and Training

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AnalysisProblem-SolvingAttention to DetailCritical ThinkingDocumenting CasesProcessing ClaimsFamiliarity with ACA GuidelinesUnderstanding of COBRAKnowledge of Benefit PlansProficiency in MS Word and Excel

Soft Skills

Strong Listening SkillsPatienceCollaborationAdvocacyEffective Verbal and Written Communication

Tools & Technologies

Internal DatabasesDual-Monitor Workstation

Industry Keywords

HIPAA ComplianceHealthcare NavigationBenefit ProgramsMotor Vehicle ClaimsBehavioral Health Benefits

About the role

Key responsibilities & impact

Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers
Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs
Educate members about benefit plans and coverage details
Process claims accurately and timely according to internal policies, procedures, and federal regulations
Collaborate with team members and escalate unresolved issues to supervisors or carriers
Mentor new team members and share best practices
Contribute to continuous process improvements
Document and track cases using internal databases
Advocate for members and help simplify healthcare navigation

Requirements

What you’ll need

At least 2 years of experience in healthcare, customer service, or claims
Experience analyzing claims, identifying root causes, and proposing practical solutions
Strong listening skills and ability to guide members with care and patience
Familiarity with plan documents, ACA guidelines, Medicare, COBRA, dental, vision, and behavioral health benefits is a plus
Proficiency in MS Word and Excel
Comfortable using internal databases to document and track cases
Private, HIPAA-compliant workspace where confidential information cannot be viewed or overheard
Sufficient desk space for a dual-monitor workstation and related equipment
Reliable high-speed internet with minimum download speed of 200 Mbps
Professional, distraction-free work environment during scheduled hours
Strong concentration, attention to detail, critical thinking, and problem-solving skills
Effective verbal and written communication skills
Ability to perform prolonged sitting, extensive computer use, frequent phone use, fingering, grasping, pulling hand-over-hand, and repetitive motions

Benefits

Comp & perks

Training and comprehensive support
Opportunities for career growth and promotion from within
Competitive pay starting at $18.00 per hour
Medical, dental, and vision coverage
401(k) with company match
Paid time off (PTO)
Health Advocate-provided computer equipment, monitors, and necessary technology
Collaborative team environment
Purpose-driven work supporting members
Advanced systems and comprehensive training