Archived listing. The details below describe a past opening.
Required Skills & Experience
· 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.
Nice to Have Skills & Experience
· 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.
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.