Job Description

Your Role

The Claims operational teams are responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Operations Manager. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases.  

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Handle the most complex and escalated claims across all processing areas with full autonomy
• Lead resolution of high-impact issues and serve as expert backup for all claim functions
• Participate in projects, process improvements, and complex problem-solving initiatives
• Mentor experienced staff and support training and knowledge transfer activities
• Act as backup for supervisory coverage as needed
• Other duties as assigned

Your Knowledge and Experience

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• 7 years of prior relevant experience
• Thorough knowledge of advanced health plan processing operations and procedures within Claims Processing with a deep understanding of end-to-end claims processing fundamentals
• Advanced-Expert skills creating documents/files using Excel, Outlook, Power Point, and Word

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.