Claims Specialist
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Health AdvocateCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims analysis and resolution, with a strong focus on member advocacy and compliance with healthcare regulations. Proficient in utilizing internal databases and MS Office tools to document and manage cases effectively.
Highest-signal resume keywords
Claims AnalysisMedicaid ExperienceMedicare ExperienceCustomer ServiceHIPAA Compliance
About the role
Key responsibilities & impact- Investigate billing discrepancies and identify claims errors
- Coordinate resolutions among members, carriers, and providers for timely claim processing
- Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs
- Educate members about benefit plans and coverage details
- Adhere 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 by simplifying healthcare navigation and resolving complex claims
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
- Proficient 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
Benefits
Comp & perks- Training and comprehensive support
- Room for growth and internal promotion opportunities
- Medical, dental, and vision coverage
- 401(k) with company match
- PTO
- Health Advocate-provided computer equipment, monitors, and necessary technology
- Advanced systems and comprehensive training
- Collaborative team environment
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 ProcessingRoot Cause AnalysisCase ManagementDocumentationProcess Improvement
Soft Skills
Strong Listening SkillsMentoringCollaborationProblem SolvingPatient Guidance
Tools & Technologies
MS WordMS ExcelInternal Databases
Industry Keywords
HealthcareBenefit ProgramsACA GuidelinesCOBRABehavioral Health Benefits