Insurance Claims Specialist

About the role

Work alongside an engaged onsite team focused on claims resolution, compliance, and customer service excellence.

Work Style: Onsite
Location Requirement: Gainesville, FL
FTE: Full-Time (1.0 FTE)

Responsibilities

• Manages and evaluates insurance claims for accuracy and timely processing.
• Investigates claims and negotiates settlements.
• Responds to inquiries from claimants and related parties.
• Assists clients in submitting claims correctly.
• Coordinates with internal teams to facilitate efficient claim resolution.
• Maintains detailed records and verifies claim compliance to support audit and regulatory requirements.

Requirements

• High School Diploma or equivalent
• 2+ years of experience in insurance claims processing and support
• Knowledge of insurance policies and claim adjudication
• Experience investigating and resolving claim issues
• Strong communication and customer service skills
• Ability to maintain detailed records and ensure compliance

Preferred Qualifications

• Experience verifying patient insurance eligibility and working with commercial and government payers, including BCBS, Medicare, Medicaid, and third-party insurance carriers
• Epic experience required; familiarity with computerized insurance billing systems and Microsoft Office programs
• Strong organizational and problem-solving skills with the ability to work independently in a fast-paced environment
• Above-average math aptitude with strong attention to detail and accuracy
• Ability to interact professionally with patients, payers, and internal teams while exercising sound judgment in account resolution
• Knowledge of medical terminology
• Demonstrated ability to consistently achieve performance expectations while managing multiple priorities under pressure