Claims Reimbursement Specialist

At NationsBenefits, we are committed to helping health plan members achieve a better quality of life through supplemental benefit solutions. We are also passionate about supporting the goals of our associates and helping them do their best work. Together, we can make a meaningful and measurable difference in the lives of millions. That’s something we can all be proud of.

It all begins with how we care about the people we serve. Since 2015, our mission has guided our principles toward delivering solutions for a rapidly changing industry. Compassionate Care is at the center of all we do, and it unites us to foster an environment where everyone is empowered, inspired, and equipped for success.

We offer a fulfilling work environment that attracts top talent and encourages all associates to do their part in delivering premier service to internal and external customers alike. It’s how we’re transforming the healthcare industry for the better. We provide career advancement opportunities from within the organization, with multiple locations in Florida, California, Pennsylvania, Tennessee, Texas, Utah, and India.

You might also like to know that NationsBenefits is also recognized as one of the fastest-growing companies in America. We’re proud of how far we’ve come, and a career with us gives you growth opportunities, too.

Role and Responsibilities

The Claims/Reimbursement Specialist is responsible for processing new claims in accordance with policies, procedures, and guidelines as outlined by NationsBenefits and contractual agreements.

Maintain confidentiality of claims dataAnalyze and investigate complicated insurance claims to help prevent fraudResolve claims in a timely mannerContacting Members for missing documentation/informationContacting insurance companies for issues of eligibility or extenuating circumstancesReviewing criteria to determine whether Member meets requirementsEnsure processes are current and updated when necessaryInteract and communicate with Finance to facilitate payments to Members

Qualifications and Education

High PC proficiency skills requiredSome experience with claims processing and/or banking backgroundAttention to detail and quality-orientedStrong oral communication skillsHigh School Diploma or equivalentHigh proficiency with the Microsoft Office Suite, including Excel

Preferred Skills

Basic Math skillsKnowledge of insurance-related policiesKnowledge of CPT , HCPS, and ICD-10 CodesExcellent conflict resolution skillsStrong written communication skillsTime Management skillsAbility to remain highly motivated in a multi-faceted environmentAnalytical thinker and problem solverAbility to multitaskListening and interpersonal skills

NationsBenefits is an Equal Opportunity Employer.