Human Resources Specialist - Claims

LifePath Systems; McKinney (TX); On-site; USD 42,000 - 64,000; Full time

Job summary

LifePath Systems in McKinney, TX is seeking a claims specialist to review, investigate, and resolve insurance claims with accuracy and regulatory compliance. The role requires strong analytical skills, attention to detail, and effective communication across teams.

The successful candidate will handle multiple priorities in a fast-paced environment, demonstrate proficiency in MS Office, and maintain professionalism in confidential situations while ensuring quality service to stakeholders.

Qualifications

• Minimum of a HS Degree or GED, some college preferred, but not required.
• Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or related administrative field.
• Strong analytical and problem-solving skills.
• High attention to detail and organizational abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent computer skills in MS Office.
• Excellent oral and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy
• Ability to present to a small or large group of new and current workforce members.
• Ability to instruct others in the use of computer and applicable software programs.

Responsibilities

• Review and evaluate incoming claims for completeness, accuracy, and eligibility.
• Investigate claims by gathering and analyzing supporting documentation.
• Verify coverage, policy provisions, contracts, or applicable guidelines.
• Process claims in accordance with company procedures and regulatory requirements.
• Identify discrepancies, potential fraud, or missing information and raise when appropriate.
• Additional duties as assigned.

Skills

Claims processing

Analytical skills

Problem-solving

Detail oriented

Communication skills

Multitasking

Education

HS Diploma or GED

Tools

MS Office

Job description

Works under the direction of the Human Resources Assistant Director and Human Resources Director with moderate latitude for the use of initiative and independent judgment. The claims specialist is responsible for reviewing, investigating, processing, and resolving claims accurately and efficiently while ensuring compliance with company policies.

• Review and evaluate incoming claims for completeness, accuracy, and eligibility.
• Investigate claims by gathering and analyzing supporting documentation.
• Verify coverage, policy provisions, contracts, or applicable guidelines.
• Process claims in accordance with company procedures and regulatory requirements.
• Identify discrepancies, potential fraud, or missing information and raise when appropriate.
• Additional duties as assigned.

Qualifications

• Minimum of a HS Degree or GED, some college preferred, but not required.
• Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or related administrative field.
• Strong analytical and problem-solving skills.
• High attention to detail and organizational abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent computer skills in MS Office.
• Excellent oral and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy,
• Ability to present to a small or large group of new and current workforce members.
• Ability to instruct others in the use of computer and applicable software programs.