Healthcare Benefits Claims Examiner Representative
Description Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Healthcare Benefits Claims Examiner Representative, you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. Reporting to the Claims Manager, the Healthcare Benefits Claims Examiner Representative is responsible for various administrative tasks related to services and claims for our health plans. The ideal candidate is detail-oriented, with exceptional communication skills, and a background in healthcare/insurance processing. We are hiring for multiple positions with a January 20, 2026 start date. Responsibilities:
- Ensure accuracy of claims adjudication while maintaining quality and turn around goals.
- Adjudicate medical, dental and vision claims.
- Review plan documents for various groups to apply appropriate benefits to claims being adjudicated.
- Prioritize assigned claims by adjudicating oldest claims first.
- Communicate effectively with internal auditors and management team.
- Perform other related duties, as assigned.
Requirements
- At least 6 months prior experience in the healthcare or insurance industry with respect to operations support, including provider maintenance, billing, coding, or customer support.
- Experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.
- Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.
- Strong interpersonal skills with excellent verbal and written communication skills.
- Keyboard and Windows skills a must.
- Ability to work using Excel spreadsheets.
- Eager to learn the TPA industry and new concepts and processes.
- Blue Care experience and medical coding and terminology a plus.
Work Environment & Physical Demands
- Prolonged periods of sitting may be required.
- Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
- Employees should ensure an ergonomically appropriate desk and chair setup.
- Comfort with being on camera for virtual meetings (e.g., Microsoft Teams).
Benefits: After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:
- Fantastic medical, dental, and vision insurance*
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
- Company provided Basic Life and AD&D
- Company paid Short-Term and Long-Term Disability**
• Flexible Spending Accounts* • 401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
- 10+ paid holidays
- Generous paid vacation and sick time
- Annual Volunteer Paid Day
- Annual Tuition Reimbursement
- Annual Health and Wellness Reimbursement
- Lots of fun company events
Who We are: As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue. With over 30 years of experience and a dedicated team of more than 200 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit https://www.cobaltbenefitsgroup.com/careers/. Benefit Waiting Period Notes:
- 60 day waiting period
- *90 day waiting period
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