Nonstop Administration & Insurance Services · 15 hours ago
Claims Specialist
United States
Full-time
Remote
Entry Level
$28.85/hr - $28.85/hr
1+ years expNonstop Administration and Insurance Services, Inc. is a fast-growing health insurance company committed to making high-quality, affordable healthcare accessible to everyone. They are seeking a detail-oriented and motivated Claims Specialist to review and process medical expense reimbursement claims submitted by Nonstop Health members.
FitnessHealth CareWellness
No H1B
Responsibilities
Review and verify accuracy of MERP reimbursement claims and supporting documentation (e.g., EOBs, provider bills, receipts)
Ensure claims meet plan eligibility and MERP-specific policy guidelines, including IRS-qualified expense criteria
Make benefit determinations by applying plan rules, allowable expense definitions, and medical necessity standards
Manage and maintain a caseload of 60+ client files, tracking each claim’s status and required follow-up
Accurately enter and process claim data into the MERP claims management and payment systems
Identify incomplete or non-allowable claims and request additional documentation as needed
When necessary, communicate clearly and compassionately with members and providers regarding claim status, documentation requirements, and denials
Coordinate closely with internal departments (e.g., Member Services, Development, Appeals etc.) to resolve issues and expedite claims
Adjudicate claims in a timely and compliant manner, issuing approvals, denials, or payment adjustments as appropriate
Initiate and monitor claim payment processes, ensuring timely check generation and mail distribution
Maintain meticulous claim records for audit readiness and compliance with HIPAA and internal data privacy standards
Support and uphold Nonstop’s commitment to quality member experience and efficient claims resolution
Qualification
Required
Understanding of IRS guidelines for qualified medical expenses and MERP plan structures
Familiarity with EOBs, provider statements, and healthcare billing practices
Proficiency in claims and payment systems, as well as Microsoft Office tools
Strong attention to detail, problem-solving skills, and ability to manage high-volume workloads
Excellent verbal and written communication skills
Commitment to confidentiality, accuracy, and member-centered service
Preferred
High school diploma or equivalent required; associate's or bachelor's degree preferred
1–3 years of experience in claims processing, healthcare administration, or reimbursement plan operations (MERP experience preferred)
Applies critical thinking and balanced judgment to solve problems and drive confident decisions
Experience working with Salesforce and Atlassian systems preferred
Must demonstrate proficiency in AI-driven tools and solutions to improve processes, optimize performance, and support continuous innovation
Benefits
Health, fully covered: 100% of medical, dental, and vision premiums for you and your dependents
Fully remote position
Technology allowance
Flexible PTO and holidays
Financial wellness: 401(k) match
Company
Nonstop Administration & Insurance Services
With Nonstop Health, organizations with over 50 members on healthcare benefits save an average of 12.5% on their healthcare spend – savings for both the employer and employee.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Paymon Farazi
CEO
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