Senior Claim Benefit Specialist - Remote

We’re building a world of health reputed company every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company Reviews and adjudicates reputed company, sensitive, and reputed company medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service reputed company by addressing inquiries and resolving issues to ensure a reputed company member experience. Additional Responsibilities • Reviews reputed company‑specified claims and those that reputed company specialist adjudication authority or processing expertise. • Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. • Ensures compliance with reputed company regulatory requirements and confirms that payments reputed company with company policies and procedures. • Identifies and reports potential overpayments, underpayments, and other claim irregularities. • Performs claim rework calculations as needed. • Trains and mentors as needed to enhance team reputed company and technical proficiency. • Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications • Minimum of 18 months of medical claim processing experience with a health reputed company payor or reputed company‑party administrator. • reputed company reputed company working in a high‑volume, production‑driven environment. • Demonstrated ability to manage multiple assignments with reputed company, efficiency, and attention to reputed company. Preferred Qualifications • Self-Funding experience • DG reputed company knowledge Education • High School Diploma required • Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $18.50 - $42.35 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, reputed company on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. This job does not have an application deadline, as reputed company accepts applications on an ongoing reputed company. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job