Claims and Member Services Representative

Job Description

Insight Global is assisting a client in finding a Claims & Member Services Representative to join a growing healthcare benefits organization located in Birmingham, AL. This individual will serve as a key point of contact for members and healthcare providers, assisting with insurance claims, eligibility questions, benefit inquiries, payment status, and portal support.

This is a fast-paced, customer-focused role that requires strong communication skills, the ability to manage a high volume of calls and emails, and a solid understanding of healthcare insurance and claims processes.

· Handle a high volume of inbound calls, emails, and other correspondence from members and healthcare providers. · Assist members with benefit inquiries, claims questions, reimbursement requests, and portal-related issues. · Support providers with claim status requests, payment inquiries, eligibility verification, and benefits information. · Research and resolve claims-related issues using multiple systems and internal resources. · Coordinate with internal teams to escalate claims requiring review, reprocessing, or additional analysis. · Update provider and member information as needed to ensure accurate claim processing and payment delivery. · Partner with Provider Relations to resolve provider filing and claim submission issues. · Respond to inquiries professionally and efficiently while maintaining a high level of customer service. · Document interactions and maintain accurate records within company systems. Utilize tools and databases to investigate and resolve complex insurance and claims inquiries.

Skills and Requirements

· Minimum 1 year of experience in a healthcare insurance, claims processing, revenue cycle, medical billing, or related environment. · Understanding of healthcare insurance claims, eligibility verification, benefits, and reimbursement processes. · Experience working with providers, patients, members, or healthcare organizations. · Strong phone presence with the ability to confidently handle high call volumes and challenging conversations. · Ability to manage multiple priorities across phone, email, and system-based workflows. · Strong problem-solving, organizational, and communication skills. Proficiency with Microsoft Office and navigating multiple systems simultaneously. · Experience working for a health insurance carrier, third-party administrator, physician practice, hospital, or revenue cycle organization. · Knowledge of claim adjudication, payment processing, and provider relations workflows. Familiarity with healthcare systems, claim management platforms, or insurance support tools.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.