Medical Claims Eligibility Specialist 2 (Remote)

The HT Group; Austin (TX); Remote; USD 65,000 - 75,000; Full time

Job summary

An established industry player is seeking a detail-oriented Remote Medical Claims Eligibility Specialist to join their dynamic team. This role involves managing and reviewing claims, ensuring compliance with legal and company procedures, and providing exceptional customer service. The ideal candidate will have over 5 years of experience in claims management, strong technical knowledge, and excellent communication skills. If you're looking to grow in a mission-driven environment with a focus on health care, this opportunity is perfect for you.

Qualifications

• 5+ years of experience in claims management and review, preferably in the insurance industry.
• Strong technical knowledge of claims processing and policy evaluation.

Responsibilities

• Investigate and evaluate claims for coverage and eligibility.
• Communicate complex claim decisions and coverage details to stakeholders.
• Provide guidance to junior staff and support team leads when needed.

Skills

Claims Management

Customer Service

Communication Skills

Policy Evaluation

Technical Knowledge

Education

LVN License

LPN License

LSW License

Job description

Medical Claims Eligibility Specialist 2 (Remote)

The HT Group has partnered with an insurance client in Austin, TX, looking for a Remote Medical Claims Eligibility Specialist who is experienced, detail-oriented, and customer-focused to review and manage claims of varying complexity. This is a great opportunity for someone looking to grow within a dynamic and mission-driven environment.

This is a fully remote position. Only candidates with LVN, LPN, or LSW certification/license will be considered.

Details:

• Fully Remote
• $65,000-$75,000
• Direct-Hire
• Monday-Friday, 8AM-5PM CST

Responsibilities:

1. Investigate and evaluate claims for coverage and eligibility
2. Analyze relevant documents to support claim decisions
3. Establish appropriate Plans of Care based on company guidelines
4. Manage short-term and limited approval claims
5. Assist with customer complaints and appeals
6. Communicate complex claim decisions and coverage details to stakeholders
7. Ensure compliance with legal and company claims-handling procedures
8. Provide guidance to junior staff and support team leads when needed

Requirements:

• 5+ years of experience in claims management and review, preferably in the insurance industry
• LVN, LPN, or LSW certification/license required
• Strong technical knowledge of claims processing and policy evaluation
• Excellent verbal and written communication skills, with empathy and professionalism
• Ability to work independently with minimal supervision

All qualified applicants may apply below or send an email to [e-mail]

*HPIND

Additional Information:

• Seniority level: Associate
• Employment type: Full-time
• Job function: Administrative, Health Care Provider, and Other
• Industry: Insurance