Healthcare Management Administrators · 1 month ago
Claims Specialist II
United States
Full-time
Remote
Mid LevelHealthcare Management Administrators is the premier third-party health plan administrator across the PNW and beyond, committed to delivering exceptional service. As a Claims Specialist, you will ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims, playing a key role in shaping a positive healthcare experience for members.
Health CareInsurance
Responsibilities
Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments with precision. This ensures financial accuracy and builds trust with both clients and members
Manage high-importance claims and vendor billing with urgency and attention to detail
Review and reply to appeals, inquiries, and other communications related to claims
Work with third-party organizations to secure payments on outstanding balances
Process case management and utilization review negotiated claims
Spot potential subrogation claims and escalate them appropriately
Actively contribute to team success by assisting colleagues when workloads peak, sharing knowledge, and fostering a collaborative environment
Qualification
Required
Experience in processing medical, dental, vision, and short-term disability claims
Strong attention to detail and accuracy in financial transactions
Ability to manage high-importance claims and vendor billing
Excellent communication skills for reviewing and replying to appeals and inquiries
Experience working with third-party organizations for payment collection
Knowledge of case management and utilization review processes
Ability to identify and escalate potential subrogation claims
Team-oriented mindset with a willingness to assist colleagues
Benefits
Comprehensive salary, pay transparency, benefits, and time off package
Personal development and growth opportunities
Company
Healthcare Management Administrators
HMA is Proving What's Possible in Healthcare®.
Founded in 1986
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Lindsay Harris
Board Member
Recent News
2025-09-30
Company data provided by crunchbase