Claims Specialist

Structure:
Contract to Hire - Hybrid Role

Pay: $20-$26/hr

Our client is seeking a Senior Claims Processor to support a long‑standing benefits organization. This role supports U.S. Benefits, a small, experienced claims processing team within a multi‑employer trust environment. This position is open due to upcoming retirements of senior claims processors and will play a key role in claims processing, auditing, adjudication logic, and knowledge transfer. The ideal candidate has strong medical and/or dental claims experience and is comfortable working in a lower‑volume, high‑accuracy environment.

Process medical and/or dental claims across the full lifecycle:

• Intake and review
• Data entry and validation
• Claims adjudication
• Follow‑ups and issue resolution
• Final claims resolution
• Audit claims processed by other team members
• Apply adjudication logic and benefit plan rules accurately
• Support claims system configuration and processing logic
• Assist with reporting, data needs, and coding requirements
• Respond to member and provider inquiries via phone and email (moderate volume)
• Collaborate with internal teams to ensure compliance and accuracy
• Maintain detailed documentation and adhere to regulatory requirements
• A few thousand claims per month that is shared across a 3–4 person team
• Emphasis on quality and accuracy over high volume

• 5+ years of medical and/or dental claims processing experience
• Strong knowledge of claims adjudication logic and appeals
• Experience auditing claims and ensuring compliance
• Familiarity with claims processing systems and configuration tools
• Experience handling customer inquiries via phone and email
• High attention to detail and ability to work independently
• Comfortable working in a small team environment
• Experience with reporting and data analysis related to claims
• Coding or system configuration experience
• Background in multi‑employer trusts or benefits administration
• Experience supporting process improvement initiatives

• Opportunity to contribute to a stable, established organization with over 100 years of history
• Strong focus on compliance, accuracy, and institutional knowledge