Job Description

Position Summary

We are seeking a detail-oriented Claims Examiner & Support Specialist I to support healthcare claims operations through accurate claims processing, provider communication, and administrative support. This role is responsible for reviewing and adjudicating delegated claims, resolving inquiries, maintaining documentation, and supporting efficient claims workflows while delivering a high level of customer service.

Key Responsibilities

Claims Processing & Review

• Review healthcare claim submissions for completeness, accuracy, and compliance with established guidelines.
• Verify claim information and support delegated claims adjudication processes.
• Process claims accurately and within required service timelines.
• Maintain awareness of payer policies, procedures, and regulatory requirements.

Provider Support & Communication

• Handle inbound calls from healthcare providers and stakeholders regarding claims inquiries.
• Provide timely and professional support related to claim status, processing questions, and issue resolution.
• Document all interactions and maintain accurate communication records.
• Escalate or resolve claim concerns as appropriate.

Administrative & Operational Support

• Perform data entry and maintain claims documentation and records.
• Log disputes and assist with claim follow-up and resolution activities.
• Process incoming claims correspondence and support department workflow.
• Complete additional administrative duties and special projects as assigned.

Qualifications

• High School Diploma or GED required.
• Minimum 1 year of call center or customer service experience preferred.
• Previous healthcare claims or claims adjudication experience preferred.
• Experience in healthcare administration or claims operations is a plus.

Required Skills & Experience

• Basic understanding of healthcare terminology, coding, and claims processing practices.
• Strong attention to detail and data accuracy.
• Excellent verbal and written communication skills.
• Ability to adapt to changing procedures and priorities.
• Proficiency with Microsoft Office (Outlook, Word, Excel, Teams).
• Comfortable working with claims processing systems and performing high-volume data entry.
• Typing proficiency of approximately 50 WPM preferred.
• Strong customer service and relationship-building skills.
• Ability to manage multiple priorities in a fast-paced environment.