Claims Specialist

Aflac

Claims Specialist processing Wellness and Hospital Indemnity insurance claims for Aflac. Providing customer service and documentation for policyholders while utilizing database systems.

Posted 6/6/2026full-timeRemote • South Carolina • 🇺🇸 United StatesJunior💰 $35,000 - $45,000 per yearWebsite

About the role

Key responsibilities & impact

reviews and processes Wellness and Hospital Indemnity insurance claims based on information submitted by policy holders
determines the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation
keys claims data while interpreting coding and medical terminology in relation to diagnoses and procedures
uses multiple core administration databases, systems and subsystems to process and transmit claims for payment or further investigation
provides prompt customer service to policy holders, providers and other internal company entities regarding claims
documents phone calls in the system and follows-up on issues if needed
contacts insured or other appropriate persons to verify the accuracy and completeness of information on claims forms and related documents
responds to inquiries from policy holders, providers, agents regarding claim status and policy provisions
provides back-up coverage for other teams as required
maintains databases and prepares and extracts information using software systems
performs various clerical duties as assigned, such as filing, photocopying, typing, maintaining databases and preparing and extracting information using software systems

Requirements

What you’ll need

High School Diploma or Equivalent
1 year of work experience
Experience and proficiency using Microsoft Office Suite software
Fluency in Spanish with the ability to translate documents

Benefits

Comp & perks

medical, dental, and vision coverage
prescription drug coverage
health care flexible spending
dependent care flexible spending
Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
401(k) plans
annual bonuses
opportunity to purchase company stock
11 paid holidays
up to 20 days PTO to be used for any reason
state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingmedical terminologydata entrydatabase managementcustomer servicedocument verificationclerical dutiesfilingtypinginformation extraction

Soft Skills

communicationattention to detailproblem-solvingorganizational skillsteam collaborationcustomer focusadaptabilityfollow-uptime managementinterpersonal skills

Certifications

High School DiplomaEquivalent