Claims Specialist

Role Overview

The Claims Specialist supports the claims and insurance functions by handling reporting for medical malpractice and non-medical malpractice events, along with related risk management notifications. Reporting to the Senior Director of Claims, this person plays a key role on the Insurance and Claims team and works closely with providers throughout the claims lifecycle.

About the Company

Envision Healthcare is a national medical group committed to delivering high-quality care to patients whenever and wherever they need it. The organization brings together clinicians and clinical support professionals across the country and values a workforce that reflects the racial, ethnic, gender, sexual orientation, and economic diversity of the communities it serves.

What You'll Do

• Manage the Claims Management inbox, including calls, mail, and faxes, then sort, prioritize, and direct requests to the right team.
• Send claims and risk-related notifications to internal and external partners in a timely way.
• Check provider insurance coverage and credentials across multiple systems and databases.
• Prepare, review, and maintain claims reports and assignment records according to established standards.
• Keep internal and external claims files complete, accurate, compliant, and current.
• Complete monthly reviews of submitted claims to confirm correctness and completeness.
• Help with coverage verification and invoice-related check requests.
• Support data gathering and reporting tied to claims mitigation objectives and team metrics.
• Maintain and update files, databases, records, reports, SOPs, templates, and documentation libraries.
• Work with internal teams and outside vendors to keep claims operations running smoothly.
• Escalate complex, sensitive, or unusual issues to the appropriate stakeholders without delay.
• Handle additional duties as assigned.

Requirements

• Clear written and verbal communication skills, with the ability to build professional relationships and communicate effectively with providers, leadership, and carriers.
• Comfort using the Microsoft Office Suite.
• Ability to identify problems, gather information, assess facts, reach sound conclusions, and fix errors.
• Strong organization and reliable follow-through.
• High School Diploma or GED required.
• At least 1 year of prior work experience required.
• Experience in property and casualty claims or insurance is preferred.
• Background in clinical, healthcare, claims, or legal work is preferred.
• Experience with the Origami Risk Information System is preferred.

Benefits

• Medical, dental, and vision coverage.
• Life and disability insurance.
• Healthcare FSA, dependent care FSA, and limited healthcare FSA.
• Transportation and parking FSAs, plus HSAs.
• Benefits eligibility from day one for qualifying employees.
• Paid time off that accrues each pay period, with a minimum of 20 days and up to 25 days per calendar year depending on position.
• 9 observed holidays.
• Paid family leave.
• Competitive salary and a comprehensive benefits package.

Additional Information

Envision Healthcare uses E-Verify to confirm employment eligibility for all newly hired employees. The company is an equal opportunity employer.

Job identification: 1688. Job category: N-Non Exempt Staff General. Posted for full-time work in the United States.