Healthcare Call Center Specialist

Insurance Claims Specialist

We are looking for an Insurance Claims Specialist to join a health insurance team in Las Vegas, Nevada in a contract-to-permanent capacity. This position focuses on supporting members and healthcare providers by resolving claim-related questions, delivering clear guidance, and ensuring each interaction is handled with care and accuracy. The ideal candidate is comfortable in a fast-paced call center setting, communicates effectively in both English and Spanish, and can balance customer service with detailed claims review responsibilities.

Responsibilities:

• Respond to incoming calls from members, medical offices, and other contacts regarding claim status, benefits-related questions, and service concerns.
• Review and correct claim details when appropriate, ensuring adjustments are completed accurately and in accordance with established guidelines.
• Provide attentive, empathetic support by identifying caller needs, addressing concerns clearly, and guiding each conversation toward resolution.
• Explain topics such as reimbursement structures, provider network participation, and coverage-related requirements in a way callers can easily understand.
• Maintain accurate records by documenting interactions, updating account information, and sharing relevant details with internal teams.
• Route inquiries to the appropriate department when needed and help resolve more complex issues through research and sound judgment.
• Use internal resources, reference materials, and decision-support tools to investigate questions and deliver dependable information.
• Educate callers on next steps, confirm understanding before ending the conversation, and contribute to service quality and departmental initiatives as assigned.