Claims Coordinator

The Claims Coordinator represents the organization in a professional manner and interacts effectively with diverse stakeholders to deliver outstanding service. This role maintains day-to-day internal claims processing operations and collaborates closely with client-facing teams and outsource partners to enhance claims efficiency, accuracy, and operational capacity. The Claims Coordinator works under general supervision to ensure compliance with service level agreements (SLAs).

The Role

• Claims Processing & Operations:
• Monitor and respond to specified Jira ticketing queues in the Jira Claims project.
• Act as an operational resource regarding claims services and procedures, responding to daily inquiries and specific claim questions from outsource partner(s) via the Jitbit claims processing system.
• Assist outsource partners and Account Management teams with reporting requests.
• Review and process Letters of Medical Necessity and Prescriptions submitted by account participants in accordance with IRS guidelines.
• Process Improvement & Quality Assurance:
• Identify potential processing bottlenecks, system issues, and opportunities for workflow enhancements.
• Monitor and analyze consistent errors or recurring questions from outsource partners and internal staff.
• Collaborate with the Claims Department Supervisor to refine training materials, update processor documentation, and share best practices to minimize recurring error rates.
• Perform ad hoc projects and additional responsibilities as assigned by department leadership.

Requirements

• Claims Processing & Technical Skills:
• Claims & TPA Knowledge: Working knowledge of third-party administration (TPA), consumer-directed health benefits, and claims adjudication processes.
• Technical Proficiency: Proficiency in Microsoft Office/Google Workspace and experience navigating Jira and Jitbit.
• Claims Knowledge: Proficiency in claims processing workflows, manual adjudication, and appeals.
• Software Capability: Aptitude for mastering and using proprietary claims processing systems.
• Analytical Proficiency: Ability to analyze complex data, identify discrepancies, and accurately calculate and process adjustments in the claims system.
• Regulatory Knowledge: Knowledge of consumer-directed health benefits regulations and all relevant HHS standards for the secure handling of Protected Health Information (PHI).
• Communication & Discretion: Excellent written, verbal, and interpersonal communication skills to explain complex issues to various stakeholders; strong email etiquette and proven ability to handle confidential information with tact and discretion.
• Credentials & Experience:
• Education & Experience: Graduation from an accredited college, university, or technical school is required.
• Background or experience in Benefits Administration.
• Prior experience in claims processing, TPA operations, or customer service is preferred.

Benefits

• Medical Insurance
• Vision Insurance
• Dental Insurance
• 401(k) Matching
• Flexible Spending Accounts
• Health Savings Accounts
• Disability & Life Insurance
• Employee Assistance Program
• LegalShield
• ID Shield
• Commuter Reimbursement Plan
• Tuition Reimbursement
• Bonus Pay

Additional Benefits Include:

• Wellable membership
• Telescope Health (telehealth) through Accresa
• Intellect (mental health) application
• Employee engagement activities, including voluntary events, raffles, book club, and more!

Physical Demands and Working Conditions:

Work in an office environment; sustain posture in a seated position for prolonged periods of time; use hands to grasp and reach; occasionally stoop or kneel; see, hear, and speak with sufficient acuity to successfully perform all aspects of the job; use telephone and write or use a keyboard to communicate through written means; lift up to ten pounds of weight.