Claims Specialist
Nonstop Administration & Insurance Services
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $29 per hour
Job Level
About the role
- Review and verify accuracy of MERP reimbursement claims and supporting documentation (e.g., EOBs, provider bills, receipts)
- Ensure claims meet plan eligibility and MERP-specific policy guidelines, including IRS-qualified expense criteria
- Make benefit determinations by applying plan rules, allowable expense definitions, and medical necessity standards
- Manage and maintain a caseload of 60+ client files, tracking each claim’s status and required follow-up
- Accurately enter and process claim data into the MERP claims management and payment systems
- Identify incomplete or non-allowable claims and request additional documentation as needed
- When necessary, communicate clearly and compassionately with members and providers regarding claim status, documentation requirements, and denials
- Coordinate closely with internal departments (e.g., Member Services, Development, Appeals etc.) to resolve issues and expedite claims
- Adjudicate claims in a timely and compliant manner, issuing approvals, denials, or payment adjustments as appropriate
- Initiate and monitor claim payment processes, ensuring timely check generation and mail distribution
- Maintain meticulous claim records for audit readiness and compliance with HIPAA and internal data privacy standards
- Support and uphold Nonstop’s commitment to quality member experience and efficient claims resolution
Requirements
- Understanding of IRS guidelines for qualified medical expenses and MERP plan structures
- Familiarity with EOBs, provider statements, and healthcare billing practices
- Proficiency in claims and payment systems, as well as Microsoft Office tools
- Strong attention to detail, problem-solving skills, and ability to manage high-volume workloads
- Excellent verbal and written communication skills
- Commitment to confidentiality, accuracy, and member-centered service
Benefits
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Applicant Tracking System Keywords
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Hard Skills & Tools
claims managementpayment systemsdata entryadjudicationmedical necessity standardsIRS guidelineshealthcare billing practicesMERP plan structuresaudit readinessdocumentation requirements
Soft Skills
attention to detailproblem-solvingcommunicationconfidentialitymember-centered servicetime managementcompassionorganizational skillscollaborationcustomer service