Claims Specialist

Website Sedona Staffing Services

Serving Waco since 2001. Free to Applicants!

Work Hours: Monday-Friday, 8 AM to 4:45 PM

ROLE:  Claims Specialist

ROLE SUMMARY: A key player in the processing of claims by providing patient, empathetic, customer service to policy-related personnel regarding their claim. This is handled via telephone, e-mail, fax, or by sending letters through the mail. In addition, perform the various claim functions as listed below.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following but other duties may be assigned:

·         Obtain insured’s information by answering inbound calls and verifying information in a friendly, timely manner.

·         Inform insured’s family by explaining processes and procedures as well as what to expect.

·         Request requirements for claim processing using internal systems and/or external vendors.

·         Prepare letters and update claim’s systems for newly reported claims.

·         Address and send follow-up on outstanding requirements for pending claims.

·         Resolve requirements received via mail, email, or faxes and ensure statuses are updated accordingly.

·         Conduct research on beneficiaries, physician’s records, medical facilities, legal documents, and other important data needed to process claims efficiently.


REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·         Strong communication, both written and verbal

·         Familiarity with multi-line phone systems and ability to route and escalate calls as needed

·         Enter relevant notes regarding any or all interactions with policy-related personnel

·         Exceptional interpersonal and rapport building skills

·         Strong time management and organizational skills

·         A patient and empathetic attitude

·         Great active listening skills

·         Adaptability and flexibility

·         Comfortable working in fast-paced environments

·         Troubleshooting skills, either basic or advanced, depending on the role and industry

·         Proficient with computers

·         Data entry


•         High school diploma or general education degree (GED).

•         Call center experience & customer service experience

Please apply at

Recruiting Office: 815 N. Hewitt Dr., Hewitt, TX 76643

Tagged as: admin, claims, clerical, excel, insurance, professional

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