Insurance Claims Specialist

Job description

Overview
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)
Manages and evaluates insurance claims to ensure accurate coverage and timely processing. Investigates claims, negotiates settlements, and responds to inquiries from claimants and related parties. Assists clients in submitting claims correctly and coordinates with internal teams to facilitate efficient claim resolution. Maintains detailed records and verifies claim compliance are key to supporting audit and regulatory requirements.
Responsibilities
Key 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 claim resolution.
• Maintains detailed records and verifies claim compliance.

Qualifications
Education
• High School Diploma/Equivalent

Required Skills & Qualifications
• 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 Experience
• Experience verifying patient insurance eligibility and working with commercial and government payers, including BCBS, Medicare, Medicaid, and third-party insurance carriers preferred
• Epic experience required, with familiarity using computerized insurance billing systems and Microsoft Office programs preferred
• Strong communication, 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 preferred
• Demonstrated ability to consistently achieve performance expectations while managing multiple priorities under pressure

Key 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 claim resolution.
• Maintains detailed records and verifies claim compliance.

Education
• High School Diploma/Equivalent

Required Skills & Qualifications
• 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 Experience
• Experience verifying patient insurance eligibility and working with commercial and government payers, including BCBS, Medicare, Medicaid, and third-party insurance carriers preferred
• Epic experience required, with familiarity using computerized insurance billing systems and Microsoft Office programs preferred
• Strong communication, 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 preferred
• Demonstrated ability to consistently achieve performance expectations while managing multiple priorities under pressure