Senior Claims Coordinator

Collabrios delivers purpose-built software solutions that unify the entire care journey. By combining deep industry expertise with cutting-edge technology, we empower care providers to streamline operations while delivering exceptional care. From PACE programs to government agencies, our integrated technology infrastructure supports the full spectrum of care delivery.

Job Overview

The Senior Claims Coordinator plays a key role in overseeing PACE claims processing and coordination. This position is responsible for ensuring claims are handled with accuracy and timeliness while also offering support and guidance to team members. The ideal candidate brings technical knowledge, collaborative problem-solving skills, and a commitment to delivering excellent service across internal and external stakeholders.

Key Responsibilities 

• Team Support: Assist in training and serve as a resource for colleagues to support team growth.
• Claims Evaluation: Review claims for completeness and accuracy to determine payment or denial based on contracts, authorizations, and Medicare/Medicaid guidelines.
• Documentation Review: Assess claims forms and supporting documentation to make appropriate coverage decisions.
• Claims Processing: Accurately and promptly process Medicare and Medicaid claim types, including Professional, Facility, and Dental.
• Stakeholder Communication: Communicate clearly and promptly with internal teams and plan stakeholders.
• Coding & Payment Accuracy: Apply appropriate coding and payment requirements to claims.
• Contract Interpretation: Analyze and interpret provider contracts to ensure proper claims handling.
• Issue Resolution: Investigate and resolve claims issues through research and adjustments.
• Decision Communication: Clearly communicate determinations to PACE organizations, providers, and other stakeholders.
• Digital Records Maintenance: Maintain accurate digital records of claim activities.
• Process Improvement: Contribute to the development and improvement of operational procedures.
• Compliance: Follow all internal policies and CMS/state regulations; complete all required training.
• Risk Flagging: Flag any potential fraud or abuse concerns to leadership.
• Cross-Functional Support: Help resolve challenges related to claims, payments, enrollment, and provider contracts.
• Collaboration: Work with internal teams to develop and suggest solutions for client concerns and service improvement.
• Client Engagement: Participate in internal and client-facing calls as needed.

What You Bring

Required:

• High school diploma or equivalent required
• 4-6 years of experience at a health plan, insurance company, or third-party administrator
• Understanding of Medicare, Medicaid, and PACE is required
• Completion of coursework or training in medical terminology, coding, and claims processing preferred
• Ability to prioritize and manage multiple tasks in a dynamic, fast-paced setting
• Strong analytical and critical-thinking skills for evaluating claims and interpreting data
• Comfortable using Microsoft Office and other computer applications
• Ability to build positive relationships and collaborate with both internal and external partners
• Strong written and verbal communication skills
• Self-starter with the ability to follow through independently on assigned work
• Experience contributing to departmental policies and procedures and communicating necessary updates

Bonus points if you have:

• Experience working with claims for PACE organizations or long-term care programs
• Familiarity with dental claim coding and processing
• Exposure to claims adjudication systems or healthcare administration platforms
• Prior involvement in developing training materials or SOPs for claims processing
• Experience participating in internal or external audits related to claims

What We Offer 

At Collabrios Health, we’re committed to fostering a workplace that supports your well-being, growth, and ability to make a meaningful impact. Here’s what you can expect when you join our team:

• A connected, virtual-first culture with a collaborative, mission-driven team
• Competitive health benefits, including medical, dental, and vision coverage
• 401(k) with company contribution
• Generous paid time off, including 15 PTO days, 2 floating holidays, and 6 sick days
• Flexibility and trust—we empower our team to manage their schedules and work in ways that support their lives
• Opportunities for learning, mentorship, and professional development
• A values-driven environment where diverse perspectives are welcomed and purpose guides our work

We’re committed to building a diverse and inclusive workplace. Collabrios is an equal opportunity employer. We welcome candidates from all backgrounds, identities, and experiences. If you’re excited about this role but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyway. You may be the right candidate for this or other roles.