Human Resources Specialist - Claims

About the role

Works under the direction of the Human Resources Assistant Director and Human Resources Director with moderate latitude for the use of initiative and independent judgment. The claims specialist is responsible for reviewing, investigating, processing, and resolving claims accurately and efficiently while ensuring compliance with company policies.

Responsibilities

• Review and evaluate incoming claims for completeness, accuracy, and eligibility.
• Investigate claims by gathering and analyzing supporting documentation.
• Verify coverage, policy provisions, contracts, or applicable guidelines.
• Process claims in accordance with company procedures and regulatory requirements.
• Identify discrepancies, potential fraud, or missing information and escalate when appropriate.
• Perform additional duties as assigned.

Qualifications

• Minimum of a high school diploma or GED; some college preferred, but not required.
• Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or a related administrative field.
• Strong analytical and problem-solving skills.
• High attention to detail and organizational abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent computer skills in MS Office.
• Excellent oral and written communication skills.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
• Ability to present to small or large groups of new and current workforce members.
• Ability to instruct others in the use of computer and applicable software programs.