Healthcare Claims Specialist

Relation Insurance Services; Tulsa (OK); On-site; USD 26,000 - 40,000; Full time

Benefits offered by this job

Family health and wellness programs

401K

Employee assistance programs

Paid time off

Paid holidays

Job summary

Relation Insurance Services in Tulsa, OK is seeking a Claims Examiner to verify, adjust, and resolve insurance claims. You will review claims for accuracy, determine eligibility based on policy terms, and communicate with providers and clients to ensure compliant processing.

This role requires at least a high school diploma and 1 year of healthcare reimbursement or claims experience, with solid analytical and communication skills.

Qualifications

• High school diploma or equivalent.
• Minimum 1 year of healthcare reimbursement or claims processing experience.
• Ability to read, analyze, and interpret guidelines, benefit documents, and government regulations.
• Intermediate computer skills including email, database activity, word processing, and spreadsheets.
• Strong analytical, problem-solving, and communication skills.

Responsibilities

• Reviews and validates claims for accuracy, completeness, and eligibility based on policy terms and guidelines.
• Analyzes, adjudicates, and resolves claims by approving or denying documentation, calculating benefit amounts, and initiating payments or composing denial letters.
• Ensures legal compliance with company policies, procedures, and applicable state and federal regulations throughout the claims process.
• Maintains accurate records of claims, settlements, denials, and related documentation.
• Addresses questions and concerns from providers, clients, and internal personnel regarding the adjudication process.
• Reports overpayments, underpayments, and irregularities to supervisors.
• Communicates with reinsurance brokers and other stakeholders to obtain necessary information for claim processing.
• Verifies member eligibility, benefit coverage, and authorizations as needed.
• Protects confidential information and ensure HIPAA compliance.
• Identifies documentation gaps or discrepancies and coordinates resolution as needed.
• Supports quality, accuracy, and consistency in claims processing through adherence to policies and procedures.
• Effectively utilizes available technology and tools, including emerging and AI‑enabled solutions, to support efficient workflows, accuracy, and a positive client service experience.
• Special projects and other duties as assigned.

Skills

Healthcare claims processing

Analytical skills

Communication skills

Time management

Education

High school diploma or equivalent

Tools

Email

Database

Word processing

Spreadsheets

Job description

Relation Insurance Services in Tulsa, OK is seeking a Claims Examiner to verify, adjust, and resolve insurance claims. You will review claims for accuracy, determine eligibility based on policy terms, and communicate with providers and clients to ensure compliant processing.

This role requires at least a high school diploma and 1 year of healthcare reimbursement or claims experience, with solid analytical and communication skills.