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)

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
- 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.