Claims Coordinator

Position Summary:

The Claims Coordinator represents the organization in a professional manner and interacts effectively with diverse stakeholders to deliver outstanding service. This role maintains day-to-day internal claims processing operations and collaborates closely with client-facing teams and outsource partners to enhance claims efficiency, accuracy, and operational capacity. The Claims Coordinator works under general supervision to ensure compliance with service level agreements (SLAs).

Principal Duties & Responsibilities:

• Claims Processing & Operations:
• • Monitor and respond to specified Jira ticketing queues in the Jira Claims project. (Intermediate)
  • Act as an operational resource regarding claims services and procedures, responding to daily inquiries and specific claim questions from outsource partner(s) via the Jitbit claims processing system. (Intermediate)
  • Assist outsource partners and Account Management teams with reporting requests. (Intermediate)
  • Review and process Letters of Medical Necessity and Prescriptions submitted by account participants in accordance with IRS guidelines. (Beginner)
• Process Improvement & Quality Assurance:
• • Identify potential processing bottlenecks, system issues, and opportunities for workflow enhancements. (Intermediate)
  • Monitor and analyze consistent errors or recurring questions from outsource partners and internal staff. (Intermediate)
  • Collaborate with the Claims Department Supervisor to refine training materials, update processor documentation, and share best practices to minimize recurring error rates. (Advanced)
  • Perform ad hoc projects and additional responsibilities as assigned by department leadership. (Beginner)

Requirements

Knowledge, Skills, and Abilities Required:

• Claims Processing & Technical Skills:
• • Claims & TPA Knowledge: Working knowledge of third-party administration (TPA), consumer-directed health benefits, and claims adjudication processes. (Intermediate)
  • Technical Proficiency: Proficiency in Microsoft Office/Google Workspace and experience navigating Jira and Jitbit. (Intermediate)
  • Claims Knowledge: Proficiency in claims processing workflows, manual adjudication, and appeals. (Intermediate)
  • Software Capability: Aptitude for mastering and using proprietary claims processing systems.(Intermediate)
  • Analytical Proficiency: Ability to analyze complex data, identify discrepancies, and accurately calculate and process adjustments in the claims system. (Intermediate)
  • Data Analysis & Problem Solving: Demonstrated capability to evaluate complex data, identify discrepancies, and accurately calculate adjustments. (Intermediate)
  • Regulatory Knowledge: Knowledge of consumer-directed health benefits regulations and all relevant HHS standards for the secure handling of Protected Health Information (PHI). (Intermediate)
  • Technical Skills: Proficiency in Microsoft Office/Google Workspace and experience navigating Jira and Jitbit. (Intermediate)
  • Communication & Discretion: Excellent written, verbal, and interpersonal communication skills to explain complex issues to various stakeholders; strong email etiquette and proven ability to handle confidential information with tact and discretion. (Intermediate)

Credentials & Experience:

• Education & Experience:
• • Graduation from an accredited college, university, or technical school is required.
  • Background or experience in Benefits Administration.
  • Prior experience in claims processing, TPA operations, or customer service is preferred.

Benefits

BENEFITS

• Medical Insurance
• Vision Insurance
• Dental Insurance
• 401(k) Matching
• Flexible Spending Accounts
• Health Savings Accounts
• Disability & Life Insurance
• Employee Assistance Program
• LegalShield
• ID Shield
• Commuter Reimbursement Plan
• Tuition Reimbursement
• Bonus Pay

ADDITIONAL BENEFITS INCLUDE:

• Wellable membership
• Telescope Health (telehealth) through Accresa
• Intellect (mental health) application
• Employee engagement activities, including voluntary events, raffles, book club, and more!

PHYSICAL DEMANDS AND WORKING CONDITIONS:

Work in an office environment; sustain posture in a seated position for prolonged periods of

time; use hands to grasp and reach; occasionally stoop or kneel; see, hear, and speak with

sufficient acuity to successfully perform all aspects of the job; use telephone and write or use a

keyboard to communicate through written means; lift up to ten pounds of weight.