Lead Medical Claims Specialist

Published March 8th, 2024

We have partnered with a leading 3rd party insurance company in Glastonbury who is looking to hire 2 individuals with solid medical claims experience.  

1. Lead – 4+ years of experience and has overseen a small team or is ready to take the next step in their career. – 26/hr
2. Bilingual – Must be able to speak English and Spanish fluently. – 23/hr

 Responsible for working in a fast-paced environment and having strong interpersonal and communication skills, attention to details, outstanding ability to multi-task and prioritize, and strong analytical skills.  Performs administrative tasks related to client health premiums and out of pocket medical expenses, interacts with clients to provide information in response to inquiries about products and services, and handle and resolve complaints by performing the following duties.

Duties and Responsibilities include the following. 

  • Determines covered insurance losses by studying provisions of a policy or certificate.
  • Establishes proof of loss by studying documentation and assembling additional information from outside sources.
  • Documents specific claims by completing and recording forms, reports, logs, and records.
  • Analyzes insurance claims to prevent fraud.
  • Prepares reports by collecting, analyzing, and summarizing information.
  • Resolves claims by approving or denying documentation, calculating benefits due, and determining compensation settlement.
  • Ensures legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
  • Maintains quality customer service by following customer services practices and responding to customer inquiries.
  • Provides legal support by assembling documentation for settlement action.
  • Protects operations by keeping claims information confidential.
  • Maintains a good relationship with insurance departments.

The position works mainly with the company’s West coast clientele, hours are 11:30-8 (3 days/week) and 9:30-6 (2 days/week)

We look forward to speaking with you!

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