Remote Claims Support Specialist II

American Medical Association; United States; Remote; USD 33,062 - 42,705; Full time

Benefits offered by this job

Incentive plan

AMA benefits

Retirement options

Job summary

American Medical Association seeks a Claims Customer Service Representative II for a remote role supporting members and providers across plans. You will handle claim status inquiries by phone or written communication and work with carriers to ensure quality claim service.

The role requires at least 2 years in life, health, or Medicare insurance, strong telephone and multitasking skills, and knowledge of claim adjudication.

Qualifications

• High school diploma or equivalent required.
• 2+ years in life, health, or Medicare insurance.
• Excellent telephone skills and professionalism.
• Experience in high-volume call center environments.
• Strong understanding of claim adjudication and benefits.
• Proficient with Microsoft Office and database systems.

Responsibilities

• Respond to incoming calls related to claim status inquiries.
• Log brief description of calls on CAMS and CAPS systems.
• Make outbound calls to support returned checks and resolve claim inquiries.
• Refer improperly handled claims to AMAI Claim Supervisor for immediate attention.
• Fulfill claim form requests for plans not administered by AMA Insurance.
• Communicate with insurance carriers or service providers to provide feedback on claims.
• Handle waiver of premium transactions, cancellations due to death, and other claim‑related transactions.
• Update contact management and send customer surveys.
• Provide information regarding benefits, eligibility, plan provisions, premium billing, and certificate changes as needed.
• Process changes to Administration System, including personal and coverage information, and send documents to callers as needed.
• Support business operations through participation in special projects assigned by the Customer Service Supervisor.
• Contribute to process improvements and operational efficiencies.
• Assist in documenting workflows and service processes to support consistency and quality.

Skills

Customer service

Call center

Communication skills

Multitasking

Time management

Relationship building

Education

High school diploma or equivalent

Insurance license preferred

Tools

Microsoft Office Suite

CAMS and CAPS

CRM systems

Job description

American Medical Association seeks a Claims Customer Service Representative II for a remote role supporting members and providers across plans. You will handle claim status inquiries by phone or written communication and work with carriers to ensure quality claim service.

The role requires at least 2 years in life, health, or Medicare insurance, strong telephone and multitasking skills, and knowledge of claim adjudication.