Claims Specialist

The Claims Specialist is responsible for the accurate timely and compliant processing and adjudication of insurance claims in accordance with company policies contractual obligations and regulatory requirements. This role requires strong analytical judgment attention to detail and effective communication while working in a fully remote environment.

This position is exclusively open to candidates who currently reside in the United States and are legally authorized to work in the U.S. Applications from individuals residing outside the United States will be rejected.

Key Responsibilities:

Review investigate and process insurance claims in accordance with established policies and procedures

Verify coverage assess liability and evaluate claim documentation for completeness and accuracy

Communicate with policyholders providers adjusters and internal stakeholders to obtain required information

Ensure claims decisions comply with federal state and contractual regulations

Document claim activities decisions and correspondence thoroughly within claims management systems

Identify potential fraud abuse or inconsistencies and escalate concerns as appropriate

Meet productivity quality and turnaround time standards

Support audits appeals and internal quality reviews

Maintain up-to-date knowledge of policy changes regulations and industry best practices

Required Qualifications:

Bachelors degree in Business Administration Finance Healthcare Administration or a related field (or equivalent experience)

25 years of experience in claims processing insurance operations or related roles

Strong knowledge of insurance policies claims workflows and regulatory requirements

Excellent analytical organizational and decision-making skills

High attention to detail and accuracy

Proficiency with claims management systems and Microsoft Office applications

Strong written and verbal communication skills

Ability to work independently and effectively in a remote environment

Preferred Qualifications:

Professional certifications such as AIC CPCU or similar credentials

Experience in healthcare property and casualty or workers compensation claims

Familiarity with compliance standards and audit processes

Compensation:

Annual Salary Range: $60000 $85000 USD based on experience expertise and geographic location

Benefits:

Comprehensive medical dental and vision insurance

401(k) retirement plan with employer matching

Paid time off paid holidays and sick leave

Life short-term and long-term disability insurance

Flexible remote work arrangement

Professional development and certification reimbursement

Employee wellness and assistance programs

Work Authorization & Residency Requirement:

Must be legally authorized to work in the United States

Must currently reside within the United States

Applications from candidates outside the U.S. will not be consideredax