Claims Resolution Specialist

About the role

As a Claims Resolution Specialist, you will be a key member of our growing Claims Operations Department, committed to delivering exceptional service and accurate outcomes.

• Process claims in alignment with implemented plan designs
• Assist the Customer Support team by responding to inquiries, supporting complex case resolution, and handling phone calls as needed
• Uphold high standards for precision, accuracy, and attention to detail in every claim you handle
• Proactively identify and communicate risks and opportunities within our claims processes
• Help prepare and track stop loss filings to ensure continuous and timely claims payments
• Play a critical role in evolving and strengthening our Claims Operations team as we scale and take on new challenges

Requirements

We’re seeking a motivated, ethical, and compassionate individual who thrives in a fast-paced, detail-oriented environment and is passionate about delivering fair and accurate outcomes.

• Experience in healthcare claims processing, preferably within a mid-sized TPA operating in the self-funded space
• A strong commitment to accuracy and attention to detail
• The ability to prioritize workload effectively in a fast-paced environment
• Strong communication skills

Qualifications

Ideal candidates would also possess:

• Experience with innovative health insurance plan designs, including Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care

Benefits

• Equity opportunities
• Health benefits
• 401K with Employer matching
• Career growth and development opportunities
• Remote capabilities

We are a high-trust team with radically high transparency and autonomy.

Pay

Approximately $48,000–$60,000 in annual salary depending on experience, location, and desired equity.