Claims Coordinator

In this role, you’ll be a key partner in ensuring claims accuracy, supporting audit processes, and delivering an exceptional experience to our provider network.

You’ll serve as a primary point of contact for providers—helping resolve claim inquiries, guiding them through audit outcomes, and ensuring all activities are handled with precision, accountability, and compliance.

What You’ll Do

• Serve as a trusted resource for providers by responding to inquiries via phone and email with professionalism, accuracy, and timely follow-up
• Research and investigate claim statuses by reviewing documentation, system data, and applicable guidelines to deliver clear and concise responses
• Act as a central point of contact for assigned hospitals and health systems, building strong and effective relationships
• Support audit processes by communicating findings, coordinating outreach, and influencing providers to obtain audit signoff
• Manage daily claims activities, including sending audit findings and appeal determination responses
• Track, monitor, and follow up on outstanding audit and claims-related items to ensure timely resolution
• Assist in obtaining and triaging provider appeals to the appropriate internal teams
• Ensure adherence to federal compliance standards, policies, and contractual requirements
• Analyze and create spreadsheets to track claims activity, audit outcomes, and provider interactions

What We’re Looking For

• High School Diploma or GED required; Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred
• 2+ years of experience in claims processing, healthcare operations, or a related environment
• Strong customer service and communication skills, with the ability to manage provider interactions professionally
• Ability to research, analyze, and resolve claims-related issues with strong attention to detail
• Comfortable navigating high-volume workflows and managing multiple priorities
• Proven ability to build relationships and effectively communicate with external partners
• Proficiency in Microsoft Excel and experience with data tracking or reporting
• Familiarity with healthcare compliance standards, audits, or appeals processes is a plus

What You Can Expect

• A fast-paced, collaborative environment where your work directly impacts provider experience and operational success
• Hands-on exposure to audit, appeals, and compliance processes
• Opportunities to grow within claims, audit, or broader healthcare operations
• A role where organization, accountability, and relationship management are key to success

Additional Information

• Must maintain confidentiality and adhere to all regulatory and compliance requirements
• Other duties as assigned