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Claims Specialist
Health Advocate. Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in investigating billing discrepancies and managing cases related to Medicaid, Medicare, and other benefit programs while adhering to federal regulations. Proficient in analyzing claims, proposing solutions, and effectively communicating with members and team members.
Highest-signal resume keywords
Claims AnalysisMedicaid ManagementMedicare KnowledgeMS Word ProficiencyMS Excel Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingBilling Discrepancy InvestigationRoot Cause AnalysisCase DocumentationProcess Improvement
Soft Skills
Strong Listening SkillsEffective CommunicationCritical ThinkingProblem-SolvingAttention to Detail
Tools & Technologies
Internal DatabasesDual-Monitor Workstation
Industry Keywords
HIPAA ComplianceACA GuidelinesCOBRABehavioral HealthDental CoverageVision Coverage
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 on benefit plans and coverage details
- Adhere to internal policies, procedures, and federal regulations when processing claims
- 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
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 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
- Ability to work in a professional, distraction-free environment during scheduled hours
- Strong concentration and attention to detail
- Critical thinking and problem-solving skills
- Effective verbal and written communication skills
Benefits
Comp & perks- Comprehensive medical, dental, and vision coverage
- 401(k) with company match
- PTO
- Comprehensive training
- Collaborative team support
- Computer equipment, monitors, and other necessary technology provided
- Competitive pay
- Opportunities to mentor and contribute to continuous process improvements