Human Resources Specialist - Claims

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.