Claims Customer Service Representative

Claims Specialist

We are partnering with a specialized health insurance client to find a dedicated Claims Specialist for a critical temporary-to-hire position. In this role, you will be the key point of contact, handling claims inquiries from customers via phone and email, interpreting contract benefits, and making determinations on the best way to process each claim. This position is ideal for a detail-oriented professional comfortable with high-volume calls and problem-solving within the Medicare and health insurance field.

Duties and Responsibilities:

• Claims Interpretation: Interpret contract benefits accurately based on the claims submitted by policyholders.
• Customer Service: Provide timely and courteous claim status updates to policy holders via phone and email.
• Correspondence: Produce necessary written correspondence, including generating refund letter requests to customers.
• Information Gathering: Place outbound calls as necessary to gather additional information required to make a determination on pending claims.
• Documentation: Maintain strong, detailed documentation for every claim interaction and decision, ensuring a clear and concise audit trail.

Experience and Qualifications:

• Education: Must have a high school diploma or equivalent.
• Communication Skills: Excellent written and verbal communication skills are required.
• Typing Speed: Must be able to type accurately at least 40 words per minute (wpm).
• Work Environment: Comfortable taking a high volume of calls and efficiently solving problems under pressure.
• Industry Experience: Previous experience in Medicare Supplements or general health care insurance is strongly preferred.

Compensation / Pay Rate (Up to): $20.25