Claims Specialist

Location: San Pedro Sula, Cortes, Honduras

• Examine, process, and calculate medical, dental, vision, gap, and related claims, ensuring accuracy and compliance with policy provisions
• Review claim filings, documentation, and reports for completeness and accuracy
• Process claims reimbursements in a timely manner
• Assist with filing and tracking short-term and long-term disability claims
• Assist with medication issues, prior authorizations, and appeals
• Verify benefits and provide accurate insurance information to providers
• Respond to inbound and outbound calls, emails, and faxes from claimants, providers, and clients
• Respond to inquiries regarding claim status, coverage, and policy interpretation
• Identify and prioritize urgent claims, communicate with team members, and assist in workload coordination to prevent backlog
• Analyze claim issues, gather necessary documentation, and resolve discrepancies
• Escalate complex claims or unresolved matters to the Claims Manager as appropriate
• Maintain confidentiality and ensure compliance with HIPAA and company policies
• Meet productivity, accuracy, and customer service standards
• Provide professional and timely communication to client groups to ensure satisfaction and service standards are met
• Document all client communications accurately in internal systems

• Minimum of 1–3 years of experience in claims processing, insurance administration, healthcare billing, or a related field.
• Strong knowledge of medical, dental, vision, disability, and ancillary insurance claims processing preferred.
• Understanding of insurance terminology, policy interpretation, and benefit verification.
• Familiarity with HIPAA regulations and confidentiality standards.
• Bilingual proficiency required: Fluent in English and Spanish (spoken and written).
• Strong analytical and problem-solving skills with high attention to detail and accuracy.
• Excellent verbal and written communication skills.
• Strong customer service orientation with the ability to handle sensitive or complex situations professionally.
• Ability to work independently while collaborating effectively within a team environment.