Claims Specialist

OverviewNonstop Administration and Insurance Services, Inc. is a fast-growing health insurance company committed to making high-quality, affordable healthcare accessible to everyone through our employer-sponsored solution, Nonstop Health®. Here, you’re joining more than a job—you’re part of a mission to transform how brokers, clients, and members experience healthcare. You’ll help build strong partnerships, grow our client base, and deliver exceptional service that truly makes a difference. We move fast, work efficiently, and innovate constantly—from automation to new products—so you can make an impact and help shape the future of healthcare.What Nonstop Is Looking ForNonstop Health is seeking a detail-oriented and motivated Claims Specialist to join our growing team. In this role, you will be responsible for reviewing and processing medical expense reimbursement claims submitted by Nonstop Health members.The ideal candidate brings strong critical thinking, attention to detail, and problem-solving skills. You’ll be expected to evaluate claim documentation accurately, apply eligibility rules consistently, and make timely benefit determinations. This role involves managing a high-volume, active caseload and collaborating closely with both members and internal teams to ensure accurate, compliant, and customer-friendly claims processing.Primary ResponsibilitiesReview and verify accuracy of MERP reimbursement claims and supporting documentation (e.g., EOBs, provider bills, receipts)Ensure claims meet plan eligibility and MERP-specific policy guidelines, including IRS-qualified expense criteriaMake benefit determinations by applying plan rules, allowable expense definitions, and medical necessity standardsManage and maintain a caseload of 60+ client files, tracking each claim’s status and required follow-upAccurately enter and process claim data into the MERP claims management and payment systemsIdentify incomplete or non-allowable claims and request additional documentation as neededWhen necessary, communicate clearly and compassionately with members and providers regarding claim status, documentation requirements, and denialsCoordinate closely with internal departments (e.g., Member Services, Development, Appeals) to resolve issues and expedite claimsAdjudicate claims in a timely and compliant manner, issuing approvals, denials, or payment adjustments as appropriateInitiate and monitor claim payment processes, ensuring timely check generation and mail distributionMaintain meticulous claim records for audit readiness and compliance with HIPAA and internal data privacy standardsSupport and uphold Nonstop’s commitment to quality member experience and efficient claims resolutionRequirementsUnderstanding of IRS guidelines for qualified medical expenses and MERP plan structuresFamiliarity with EOBs, provider statements, and healthcare billing practicesProficiency in claims and payment systems, as well as Microsoft Office toolsStrong attention to detail, problem-solving skills, and ability to manage high-volume workloadsExcellent verbal and written communication skillsCommitment to confidentiality, accuracy, and member-centered servicePreferred Skills, Experience And EducationHigh school diploma or equivalent required; associate's or bachelor’s degree preferred1–3 years of experience in claims processing, healthcare administration, or reimbursement plan operations (MERP experience preferred)Applies critical thinking and balanced judgment to solve problems and drive confident decisionsExperience working with Salesforce and Atlassian systems preferredMust demonstrate proficiency in AI-driven tools and solutions to improve processes, optimize performance, and support continuous innovationWork Environment And Essential Functions Of The JobRemote role with regular collaboration via video, phone, email, and messaging platformsAbility to travel for team meetings, trainings, or company eventsAccess to a quiet, distraction-free workspace suitable for confidential workReliable high-speed internet connectionCollaborates efficiently and communicates clearly in fast-paced, cross-functional environmentsAbility to use a computer and productivity software for extended periodsAbility to communicate clearly in both verbal and written formatsReasonable accommodations will be provided as neededWhy You’ll Love Working HereHealth, fully covered: 100% of medical, dental, and vision premiums for you and your dependentsFully remote positionTechnology allowanceFlexible PTO and holidaysFinancial wellness: 401(k) matchMake an impact: Your work truly matters every dayPay Rate - $28.85Employment EligibilityApplicants must be legally authorized to work in the United States without current or future sponsorship. Nonstop is unable to sponsor or assume sponsorship of employment visas at this time.Nonstop provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. #J-18808-Ljbffr