Claims Technical Review Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Technical Review Specialist based in United States.

This role provides an opportunity to apply advanced claims expertise while ensuring accurate, compliant, and efficient healthcare benefit processing.
The successful candidate will perform detailed technical reviews of complex claims, interpret benefit plans, and support resolution of challenging cases.
Working within a collaborative healthcare administration environment, this position requires strong analytical skills, attention to detail, and regulatory awareness.
You will contribute to high-quality member experiences by ensuring claims decisions are accurate, well-documented, and aligned with plan requirements.
The role involves reviewing complex benefit scenarios, coordinating appeals, managing recovery processes, and supporting operational improvements.
This is an opportunity to make a meaningful impact within a team focused on service excellence, accuracy, and continuous improvement.