For those who want to keep growing, learning, and evolving. We at Kelly® hear you, and we’re here for you! We’re seeking a Claims Specialist to work at a leading organization in Richardson, TX. Sound good? Take a closer look below. You owe it to yourself to consider this great new opportunity.

Pay Rate: $35.00/hour (Contract till end of year, possible extension or hire depending on business needs)

Shift: 1st (Hybrid schedule available after training)

What’s a typical day as a Claims Specialist? You’ll be:

• Analyzing, processing, and recommending approval or denial of insurance claims including Hospital Indemnity, Critical Illness/Specified Disease, Accident Insurance, Life products, and weekly income claims.
  

• Adjudicating claims in accordance with established policies, procedures, and regulatory guidelines.
  

• Calculating multiple benefits based on claim forms, medical information, plan certificates/contracts, and regulations.
  

• Obtaining complete and accurate information from groups, agencies, physicians, beneficiaries, claimants, etc., to verify claim eligibility and resolve investigation issues.
  

• Maintaining or exceeding department production, quality, and service standards.
  

• Promoting a positive customer service image through prompt, accurate, and courteous responses to customer needs.
  

• Providing professional, prompt, and accurate customer service via telephone and in writing.
  

• Investigating, researching, and verifying information on all claim types to confirm eligibility and ensure sufficient information is obtained.
  

• Maintaining required levels of confidentiality and accurate documentation in claim files.
  

• Maintaining thorough knowledge of policies, statutes, regulations, medical conditions, and departmental procedures.
  

• Recommending changes to management to avoid recurring customer inquiries/problems.
  

• Fully investigating all relevant claim issues and providing approvals, payments, or denials promptly and in full compliance with departmental procedures and regulations.

This job might be an outstanding fit if you:

• Hold a Bachelor’s degree or have 4 years of equivalent business/related work experience (must have).
  

• Have strong decision-making, problem-solving, and research skills with the ability to analyze complex information.
  

• Are proficient with MS Word, Excel, SharePoint, and Outlook (must have).
  

• Demonstrate excellent customer service skills and attention to detail.
  

• Can maintain high levels of quality and accuracy in a fast-paced environment.
  

• Possess clear and concise verbal and written communication skills.
  

• Have knowledge of medical terminology (preferred).
  

• Have completed HIAA, LOMA, or ICA courses (preferred).
  

• Possess strong math and critical thinking skills (preferred).
  

• Are familiar with state regulations, statutes, and ERISA (preferred).
  

• Have experience with core systems such as ECM, STAR Claim System, Genelco/GIAS, Salesforce, UTS, Benefits Manager (preferred).
  

• Have knowledge in one of the following claim types: Critical Illness/Specified Disease, Accidental Insurance, Hospital Indemnity, or Short-Term Disability (preferred).
  

• Ability to fluently speak and write Spanish is a plus.

What happens next

Once you apply, you’ll proceed to next steps if your skills and experience look like a good fit. But don’t worry—even if this position doesn’t work out, you’re still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.

Helping you discover what’s next in your career is what we’re all about, so let’s get to work. Apply to be a Claims Specialist today!

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