Works under the direction of the Human Resources Assistant Director and Human Resources Director with moderate latitude for the use of initiative and independent judgment. The claims specialist is responsible for reviewing, investigating, processing, and resolving claims accurately and efficiently while ensuring compliance with company policies.
- Review and evaluate incoming claims for completeness, accuracy, and eligibility.
- Investigate claims by gathering and analyzing supporting documentation.
- Verify coverage, policy provisions, contracts, or applicable guidelines.
- Process claims in accordance with company procedures and regulatory requirements.
- Identify discrepancies, potential fraud, or missing information and escalate when appropriate.
- Additional duties as assigned.
Qualifications
- Minimum of a HS Degree or GED, some college preferred, but not required.
- Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or related administrative field.
- Strong analytical and problem-solving skills.
- High attention to detail and organizational abilities.
- Ability to manage multiple priorities in a fast-paced environment.
- Excellent computer skills in MS Office.
- Excellent oral and written communication skills.
- Excellent organizational skills and attention to detail.
- Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy,
- Ability to present to a small or large group of new and current workforce members.
- Ability to instruct others in the use of computer and applicable software programs.
Skills Required
- High school degree or GED
- At least 2 years of experience in claims processing, customer service, insurance, healthcare, or a related administrative field
- Strong analytical and problem-solving skills
- High attention to detail and organizational abilities
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency with Microsoft Office
- Excellent oral and written communication skills
- Excellent organizational skills and attention to detail
- Interpersonal skills for managing sensitive and confidential situations with tact, professionalism, and diplomacy
- Ability to present to small or large groups of new and current workforce members
- Ability to instruct others in the use of computers and applicable software programs
- Some college education
What We Do
LifePath Systems is the designated behavioral health and intellectual and developmental disabilities authority for Collin County, Texas. Operating as a unit of local government and a not-for-profit center, it provides comprehensive mental health, substance use, and intellectual and developmental disability services to residents of the county. The organization is funded by federal, state, and local sources to serve individuals and families impacted by these challenges.
