Claims Specialist

Jobtailor; Des Moines (IA); On-site; USD 42,000 - 63,000; Full time

Job summary

Jobtailor seeks an insurance claims processor to handle lifecycle claims processing for life and health products. You will review, adjust, and finalize routine claims, coordinate benefits, and respond to inquiries from agents, policyholders, and providers.

The ideal candidate has strong HIPAA familiarity, solid data entry and MS Office skills, and a high school diploma or GED. Prior claims experience is a plus; you will work to meet compliance and performance metrics.

Qualifications

• General knowledge of the principles, processes, and practices related to claims processing, including local, state, and government insurance policies.
• Strong verbal and written communication skills.
• Intermediate computer skills with basic knowledge of MS Office Suite (Excel, Word, and PowerPoint).
• Ability to meet or exceed procedural, financial, quality, production, adjudication, and state and federal compliance metrics.
• Acts in accordance with HIPAA Privacy and Security guidelines.
• High school diploma or GED equivalent.
• Previous related experience is a plus.

Responsibilities

• Process, review, and adjust routine life or health claims.
• Review, analyze, and process claims, adjustments, coordination of benefits, and refunds.
• Enter codes and data accurately into applicable systems.
• Refer more complex claims to a more experienced specialist.
• Handle final expense or preneed life products.
• Handle Medicare Supplement, Dental, Hospital Indemnity, or related health products.
• Respond to agent, policyholder, and provider inquiries about policy coverage and related information by phone, email, letter, or other channels.
• Cross-train on additional health products.
• Back up medical records, transmittal, provider files, or other related duties.

Skills

Claims Processing

HIPAA Compliance

MS Office Suite

Verbal Communication

Written Communication

Education

High School Diploma

GED Equivalent

Tools

MS Office Suite

Job description

• Process, review, and adjust routine life or health claims
• Review, analyze, and process claims, adjustments, coordination of benefits, and refunds
• Enter codes and data accurately into applicable systems
• Refer more complex claims to a more experienced specialist
• Handle final expense or preneed life products
• Handle Medicare Supplement, Dental, Hospital Indemnity, or related health products
• Respond to agent, policyholder, and provider inquiries about policy coverage and related information by phone, email, letter, or other channels
• Cross-train on additional health products
• Back up medical records, transmittal, provider files, or other related duties

Requirements

• General knowledge of the principles, processes, and practices related to claims processing, including local, state, and government insurance‑related policies
• Strong verbal and written communication skills
• Intermediate computer skills with basic knowledge of MS Office Suite (Excel, Word, and PowerPoint)
• Ability to meet or exceed procedural, financial, quality, production, adjudication, and state and federal compliance metrics
• Acts in accordance with HIPAA Privacy and Security guidelines
• High school diploma or GED equivalent
• Previous related experience is a plus

Core Competencies

Demonstrates expertise in claims processing, including handling life and health claims, while ensuring compliance with HIPAA guidelines and state and federal regulations. Proficient in data entry and communication with agents, policyholders, and providers regarding policy coverage.

Highest-signal resume keywords

• Claims Processing
• HIPAA Compliance
• MS Office Suite
• Verbal Communication
• Written Communication

Hard Skills

• Claims Review
• Data Entry
• Adjustments Processing
• Coordination of Benefits
• Refund Processing

Soft Skills

• Strong Communication Skills

Certifications & Qualifications

• High School Diploma
• GED Equivalent

Industry Keywords

• Life Insurance
• Health Insurance
• Medicare Supplement
• Dental Products
• Hospital Indemnity