Medical Claims Specialist & Benefits Advocate

Valeris, Inc.; Raleigh (NC); On-site; USD 52,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

401(k) with company match

Paid time off and holidays

EAP services

HSA- and FSA-eligible options

Job summary

Valeris, Inc. is seeking a Medical Claims Specialist to handle provider offices using Valeris' medical benefit copay programs. You will troubleshoot claims, investigate status, and coordinate with external vendors to resolve escalations while delivering exceptional service.

The role requires experience in medical claims workflows, strong communication, and the ability to manage multiple escalations in a fast-paced environment. A degree is preferred, with healthcare experience a plus.

Qualifications

• Associate or Bachelor’s degree preferred; or 5+ years of customer service/medical claim experience.
• Strong understanding of medical claims processing, rejections, reversals and provider workflows.
• Excellent verbal and written communication skills with stakeholders.

Responsibilities

• Manages day-to-day activities and escalations of multiple medical benefit copay programs.
• Acts as advocate delivering detailed information for various medical claim scenarios.
• Serves as focal point for provider medical claim escalations and issues.
• Outreaches to provider sites, patients and stakeholders with supported programs.
• Maintains records in accordance with applicable standards and regulations.

Skills

Customer service

Medical claims knowledge

Verbal & written communication

Vendor management

Multi-tasking

Attention to detail

Education

Associate or Bachelor’s degree preferred

5+ years of customer service/medical claim experience

Tools

MS Excel

Job description

Valeris, Inc. is seeking a Medical Claims Specialist to handle provider offices using Valeris' medical benefit copay programs. You will troubleshoot claims, investigate status, and coordinate with external vendors to resolve escalations while delivering exceptional service.

The role requires experience in medical claims workflows, strong communication, and the ability to manage multiple escalations in a fast-paced environment. A degree is preferred, with healthcare experience a plus.