Aflac, a Fortune 500 company and an industry leader in voluntary insurance products, is seeking a Claims Specialist. The role is remote, performed from home within the continental US, though occasional office visits may be requested based on business need (communicated in advance). Under immediate supervision and following established policies and procedures, the specialist reviews and processes Wellness, Accident and Vision insurance claims. Salary range: $37,000-$43,680. Job posting end date: June 29, 2026.
Responsibilities
- ▹Review and process Wellness, Accident and Vision insurance claims based on information submitted by policy holders
- ▹Determine the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation
- ▹Key claims data while interpreting coding and medical terminology in relation to diagnoses and procedures
- ▹Use multiple core administration databases, systems and subsystems to process and transmit claims for payment or further investigation
- ▹Provide prompt customer service to policy holders, providers and internal company entities regarding claims
- ▹Document phone calls in the system and follow up on issues as needed
- ▹Contact insured or other appropriate persons to verify the accuracy and completeness of claims forms and related documents
- ▹Respond to inquiries from policy holders, providers and agents regarding claim status
Requirements
- ▹High School Diploma or Equivalent
- ▹1 year of work experience
- ▹Experience and proficiency using Microsoft Office Suite software
- ▹Knowledge of principles and processes for providing customer and personal services (needs assessment, quality standards, evaluation of customer satisfaction)
- ▹Knowledge of administrative and clerical procedures and systems (word processing, managing files and records)
- ▹Skill in using mathematics to solve problems
Nice to have
- ▹Experience with medical terminology
- ▹For this position: fluency in Spanish with the ability to translate documents
- ▹Or an equivalent combination of education and experience
Soft skills
About the company
Aflac is a Fortune 500 company, an industry leader in voluntary insurance products that pay cash directly to policyholders, and one of America's best-known brands. It has been recognized as one of Fortune's 50 Best Workplaces for Diversity and as one of the World's Most Ethical Companies by Ethisphere.com. Its business is about being there for people in need.