Reviews, investigates, verifies, processes, and resolves claims while ensuring accuracy, policy compliance, and adherence to regulatory requirements. Gathers supporting documentation, identifies discrepancies or potential fraud, escalates issues, and manages confidential information. The role also requires strong communication, organization, computer skills, and the ability to present information and instruct workforce members on applicable software.
Works under the direction of the Human Resources Assistant Director and Human Resources Director with moderate latitude for the use of initiative and independent judgment. The claims specialist is responsible for reviewing, investigating, processing, and resolving claims accurately and efficiently while ensuring compliance with company policies.
- Review and evaluate incoming claims for completeness, accuracy, and eligibility.
- Investigate claims by gathering and analyzing supporting documentation.
- Verify coverage, policy provisions, contracts, or applicable guidelines.
- Process claims in accordance with company procedures and regulatory requirements.
- Identify discrepancies, potential fraud, or missing information and escalate when appropriate.
- Additional duties as assigned.
Qualifications
- Minimum of a HS Degree or GED, some college preferred, but not required.
- Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or related administrative field.
- Strong analytical and problem-solving skills.
- High attention to detail and organizational abilities.
- Ability to manage multiple priorities in a fast-paced environment.
- Excellent computer skills in MS Office.
- Excellent oral and written communication skills.
- Excellent organizational skills and attention to detail.
- Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy,
- Ability to present to a small or large group of new and current workforce members.
- Ability to instruct others in the use of computer and applicable software programs.
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What you need to know about the Austin Tech Scene
Austin has a diverse and thriving tech ecosystem thanks to home-grown companies like Dell and major campuses for IBM, AMD and Apple. The state’s flagship university, the University of Texas at Austin, is known for its engineering school, and the city is known for its annual South by Southwest tech and media conference. Austin’s tech scene spans many verticals, but it’s particularly known for hardware, including semiconductors, as well as AI, biotechnology and cloud computing. And its food and music scene, low taxes and favorable climate has made the city a destination for tech workers from across the country.
Key Facts About Austin Tech
- Number of Tech Workers: 180,500; 13.7% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Dell, IBM, AMD, Apple, Alphabet
- Key Industries: Artificial intelligence, hardware, cloud computing, software, healthtech
- Funding Landscape: $4.5 billion in VC funding in 2024 (Pitchbook)
- Notable Investors: Live Oak Ventures, Austin Ventures, Hinge Capital, Gigafund, KdT Ventures, Next Coast Ventures, Silverton Partners
- Research Centers and Universities: University of Texas, Southwestern University, Texas State University, Center for Complex Quantum Systems, Oden Institute for Computational Engineering and Sciences, Texas Advanced Computing Center
