[Hiring] Claims Coordinator @AE Perkins

Role Description

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).

Qualifications

• 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.

Requirements

• 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)
• 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)
• 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)
• 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)

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
• Wellable membership
• Telescope Health (telehealth) through Accresa
• Intellect (mental health) application
• Employee engagement activities, including voluntary events, raffles, book club, and more!