SPE-Claims HC

About the role

This role focuses on delivering high quality support and analysis for healthcare products within commercial claims operations in a day shift office environment. The specialist will apply domain expertise to interpret claims resolve issues and improve processing efficiency while ensuring compliance with company standards and regulatory expectations.

What you'll do

• Analyze commercial healthcare claims data in detail to ensure accurate adjudication and compliance with internal policies and industry regulations driving reliable claim…
• Collaborate with cross functional teams to clarify claim requirements product rules and benefit structures helping to minimize processing errors and improve end user…
• Review complex healthcare product configurations related to commercial claims identifying gaps or inconsistencies and recommending adjustments that enhance claim…
• Coordinate with operations and quality teams to investigate claim discrepancies document root causes and support remediation activities that reduce rework and improve…
• Support process improvement initiatives by tracking key metrics for commercial claims proposing practical changes that improve efficiency reduce manual effort and…

What you need

• 2–4 yrs of experience
• Compliance
• Audit
• Any graduate