Claims Specialist

We are seeking a detail-oriented Claims Specialist to handle and process insurance claims efficiently and accurately. The ideal candidate will have experience reviewing claims, verifying information, and ensuring compliance with company policies and industry regulations. This role requires excellent analytical skills, customer service abilities, and attention to detail.

This is a 100% remote position, requiring strong self-management skills and the ability to work independently while staying connected with the team.

Key Responsibilities:

• Review and process insurance claims accurately and in a timely manner.

• Verify claim information, including policy details, coverage, and supporting documentation.

• Investigate claims by gathering necessary data and collaborating with relevant parties.

• Communicate with policyholders, healthcare providers, or other stakeholders to resolve claim-related inquiries.

• Ensure compliance with company policies, industry regulations, and legal requirements.

• Identify potential fraud or discrepancies in claims and report as needed.

• Maintain thorough and organized records of claim transactions and decisions.

• Provide excellent customer service by addressing concerns and explaining claim decisions.

Requirements:

• Education: High school diploma or equivalent required; Associates or Bachelors degree in Business, Finance, Insurance, or a related field is a plus.

• Experience

  • 1+ years of experience in claims processing, insurance, healthcare, or a related field.

  • Familiarity with medical, auto, property, or workers' compensation claims is a plus.

• Technical Skills

  • Experience with claims processing software and CRM tools.

  • Strong knowledge of insurance policies, regulations, and industry standards.

  • Proficiency in Microsoft Office (Excel, Word, Outlook) and data entry systems.

• Soft Skills

  • Strong attention to detail and problem-solving skills.

  • Excellent verbal and written communication skills.

  • Ability to work independently and meet deadlines in a remote environment.

  • Strong customer service skills with a professional approach.

Preferred Qualifications:

• Experience in a specific claims field (e.g., health, auto, property, workers' compensation).

• Knowledge of ICD-10, CPT codes (for healthcare claims).

• Certification in insurance claims handling (e.g., AIC, CPCU, or similar) is a plus.

Benefits:

• Competitive salary based on experience.

• Fully remote work with flexible scheduling.

• Health, dental, and vision insurance.

• Paid time off and company holidays.

• Professional development and certification assistance.