Claims Specialist

Nonstop Wellness; California (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

Nonstop Wellness is seeking a detail-oriented Claims Specialist to review and process medical expense reimbursement claims. The role requires strong critical thinking and problem-solving skills while managing high volumes of claims accurately and efficiently. Join a mission-driven team committed to quality member experience and healthcare access.

Benefits

Technology allowance

401(k) with employer-matched contributions

100% employer-paid medical, dental and vision benefits

Voluntary benefits for employees and dependents

Qualifications

• 1–3 years of experience in claims processing or healthcare administration.
• Understanding of IRS guidelines and healthcare billing practices.
• Commitment to confidentiality and accuracy.

Responsibilities

• Review and verify accuracy of MERP reimbursement claims.
• Manage a caseload of 60+ client files.
• Communicate clearly with members regarding claim status.

Skills

Attention to detail

Problem-solving

Critical thinking

Communication

Education

High school diploma or equivalent

Associate's or bachelor’s degree

Tools

Microsoft Office

Claims and payment systems

Job description

Description

Who We Are:

Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance organization with a firm belief that everyone should have access to high-quality, affordable healthcare. We offer an employer-sponsored group health insurance solution called Nonstop Wellness to achieve this goal.

What Nonstop Is Looking For:

Nonstop Health is seeking a detail-oriented and motivated Claims Specialist to join our growing team. In this role, you will be responsible for reviewing and processing medical expense reimbursement claims submitted by Nonstop Health members.

The ideal candidate brings strong critical thinking, attention to detail, and problem-solving skills. You’ll be expected to evaluate claim documentation accurately, apply eligibility rules consistently, and make timely benefit determinations. This role involves managing a high-volume, active caseload and collaborating closely with both members and internal teams to ensure accurate, compliant, and customer-friendly claims processing.

Primary Responsibilities

• 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

Qualifications

• High school diploma or equivalent required; associate's or bachelor’s degree preferred
• 1–3 years of experience in claims processing, healthcare administration, or reimbursement plan operations (MERP experience preferred)
• 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

Why Join Nonstop?
At Nonstop, we’re more than just a benefits administrator - we’re a mission-driven team that believes everyone deserves high-quality healthcare access and support. Join us in reshaping how people experience and navigate health benefits.

Preferred Skills and Experience:

• Proficient with Google Suite products (Sheets, Docs, etc.) or equivalents
• Familiarity with medical insurance and medical benefits

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer per day
• Repetitive use of fingers, hands, elbows, arms, including typing, reaching, grasping, and writing
• Ability to lift, carry, push, pull, and carry 5-30 pounds occasionally
• Hearing and speaking ability sufficient to carry on a conversation with another individual (or groups of individuals) in person and over the telephone.
• Visual ability sufficient to read and produce printed material and information displayed on a computer screen

Perks and Compensation:

• Full-time / Non-exempt / Hourly Position
• Pay Rate: $28.85/hr
• Technology allowance
• Fully Remote Position (Virtual / Work From Home)
• 401(k) plan participation with employer-matched contributions
• Full medical, dental, and vision benefits with 100% employer-paid premiums after the introductory period is met
• Voluntary Benefits offered for employees and dependents

Nonstop provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.