Claimant Review Specialist

Position Overview
The Claimant Review Specialist will serve as a key support role within the Program, responsible for fielding inquiries related to claims, payments, and administrative processes. This position will act as a liaison between departments such as Claims, Accounts Payable, and Case Management to investigate and resolve issues raised by claimants, vendors, or internal staff. The role requires strong research skills, attention to detail, and the ability to communicate findings clearly and professionally. This position is Exempt under the Fair Labor Standards Act (FLSA) and reports to the Director of Claims or designee.

Duties and Responsibilities:

• Respond to inquiries regarding the status of claims, payments, or other administrative matters.

• Research and resolve issues related to delayed, misprocessed, or missing payments by reviewing digital and hard copy records.

• Collaborate with Claims, Accounts Payable, and other departments to gather information and provide accurate, timely responses.

• Track and document inquiries and resolutions to ensure follow-up and identify recurring issues.

• Assist in triaging requests to appropriate departments when further action is needed.

• Maintain organized records of communications and findings in accordance with Program policies.

• Identify process gaps or inefficiencies and recommend improvements to enhance claimant service.

• Support internal audits and quality assurance efforts by providing documentation and summaries of case reviews.

• Participate in special projects and other duties as assigned.

Qualifications:

• Strong analytical and problem-solving skills with the ability to synthesize information from multiple sources.

• Excellent verbal and written communication skills.

• Ability to manage multiple inquiries simultaneously and prioritize effectively.

• High level of professionalism and discretion when handling sensitive information.

• Strong collaboration skills and ability to work across departments.

Education & Experience:

• Associate’s or Bachelor’s degree in Business Administration, Human Services, or a related field preferred.

• 2+ years of experience in claims processing, customer service, or administrative support.

• Experience in healthcare, insurance, or public benefit programs is a plus.

• Proficiency in Microsoft Office, Excel, and QuickBooks is required.

• Must maintain confidentiality and abide by HIPAA and organizational policies.

Virginia Birth Injury is an Equal Opportunity Employer. Virginia Birth Injury does not discriminate in hiring or employment practices based on race, color, religion, gender, age, sexual orientation, marital or family status, national origin, non-job-related disability, or status as a veteran.