Claims Specialist

## About the Role As a Claims Specialist at DTLA Benefits, you will play a critical role in reviewing and processing insurance claims, ensuring that policyholders receive prompt and accurate service. This role is an excellent opportunity for individuals with strong analytical and communication skills to join a dynamic team and contribute to the company's mission of providing excellent customer experiences. The Claims Specialist will work closely with the claims team to review and process claims, determine the nature and validity of claims, and provide customer service to policyholders, providers, and internal company entities. The ideal candidate will have experience with insurance claims processing, excellent communication skills, and the ability to work in a fast-paced environment.

## What You Will Do - Review and process Wellness, Accident, and Vision insurance claims based on information submitted by policyholders - Determine the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation - Key claims data while interpreting coding and medical terminology in relation to diagnoses and procedures - Use multiple core administration databases, systems, and subsystems to process and transmit claims for payment or further investigation - Provide prompt customer service to policyholders, providers, and other internal company entities regarding claims - Document phone calls in the system and follow-up on issues if needed - Contact insured or other appropriate persons to verify the accuracy and completeness of information on claims forms and related documents - Respond to inquiries from policyholders, providers, agents regarding claim status and policy provision

## What We Are Looking For - High School Diploma or Equivalent - 1 year of work experience - Experience and proficiency using Microsoft Office Suite software - Knowledge of principles and processes for providing customer and personal services - Knowledge of administrative and clerical procedures and systems - Skill in giving full attention to what other people are saying, taking time to understand the points being made - Skill in using mathematics to solve problems - Skill in selecting and using training/instructional methods and procedures when learning new policies, procedures, concepts, or products

## Nice to Have - Experience with medical terminology - Fluency in Spanish with the ability to translate documents - Equivalent combination of education and experience

## Benefits and Perks - Remote work opportunities - Professional development and growth opportunities - Comprehensive benefits package - Paid time off and holidays - Flexible work arrangements - Access to cutting-edge technology and tools - Collaborative and dynamic work environment

- To stand out in this role, highlight your experience with insurance claims processing and customer service in your application.

• Familiarize yourself with the company's products and services to demonstrate your knowledge and enthusiasm during the interview process.
• Be prepared to provide specific examples of times when you had to interpret complex information, such as medical terminology, and explain it in simple terms.
• Showcase your proficiency in Microsoft Office Suite, particularly in Excel, as it is a crucial tool for this role.
• When negotiating salary, consider the company's remote work policy and the potential cost savings of working from home.
• Be cautious of companies that do not provide clear information about their remote work policies or benefits.