Claims Specialist

We’re looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you’ll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise.

Key Responsibilities

• Accurately process claims within established timelines
• Review and complete claim adjustment requests
• Research claim reversal requests to determine approval or denial
• Manage debit card dispute workflows, including fraudulent or disputed transactions
• Provide clear and professional responses to routine phone and written inquiries related to claim processing
• Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules
• Adjudicate transactions that fail auto-review and determine whether additional documentation is needed

Requirements

• High School Diploma or equivalent
• Knowledge of ERISA guidelines preferred
• Strong written and verbal communication skills with excellent attention to detail
• Ability to manage multiple priorities using strong organizational and time-management skills
• Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally
• Self-starter who can work independently in a fast-paced environment with critical deadlines

Why You’ll Love Working With Us

• Health Insurance
• Medical Expense Reimbursement Account (covers most out-of-pocket costs)
• Dental Insurance (100% employer-paid)
• Vision Insurance
• Free Monthly Commuter Pass
• Employer-Paid Short- & Long-Term Disability
• 401(k) with Employer Match
• Casual Dress Environment
• And more!

An Equal Opportunity Employer

Job Type: Full-time

Pay: $16.00 - $18.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• How many years of claims processing or claim adjudication experience do you have?
• Are you familiar with ERISA guidelines?
• This role requires managing multiple deadlines. Are you comfortable working in a fast-paced environment?

Work Location: Hybrid remote in Williamsville, NY 14221