Claims Specialist (Employee Benefits)

About the role

GBS Benefits, Inc. is the leader in experience, innovation, and services when it comes to customizing the employee benefits offerings for our clients. GBS Benefits has created a culture of respect, trust, hard work, and fun. When you love your job and the people around you, remarkable things can happen. We carry great excitement in our work, knowing that we have a tremendous positive impact on the larger scale. We partner with over 1,000 companies in building and protecting their dreams and visions. We invite you to investigate this job opportunity at GBS. This job description will not be all inclusive but is intended to give you a road map and an overview. Come make a difference with us! The Claims Specialist delivers white-glove healthcare advocacy to members of employer groups that partner with GBS. This is a challenging and deeply rewarding role for someone who enjoys problem-solving, investigation, and helping others navigate complex situations with confidence. As a Claims Specialist, you will act as a trusted guide-owning member issues from start to resolution, advocating on their behalf, and ensuring they feel informed, supported, and cared for throughout the process.

Responsibilities

• Serve as a primary point of contact for members needing help navigating healthcare benefits and claims.
• Investigate and resolve denied or complex medical and pharmacy claims.
• Analyze Explanation of Benefits (EOBs), plan provisions, and coding to determine next steps.
• Advocate with insurance carriers, administrators, and providers to achieve fair and timely resolutions.
• Clearly communicate plans, timelines, and outcomes while providing reassurance and support.
• Build strong relationships with internal teams and external carrier contacts.
• Document cases accurately and stay current on evolving healthcare and benefits information.
• Essential Duties and Responsibilities:
• A strong investigative and analytical mindset with attention to detail.
• High levels of empathy, professionalism, and emotional intelligence.
• Excellent written and verbal communication skills.
• Ability to manage multiple cases in a fast-paced, constantly changing environment.
• A collaborative, "can-do" attitude with a willingness to jump in and help.
• Comfort seeing both the details and the big picture.
• Prior experience with insurance, claims, benefits, or EOBs is highly preferred.
• Proficiency with Microsoft Office and comfort learning new systems.
• Skills and Knowledge:
• Sound reasoning and judgment to decipher a multitude of incoming issues.
• Maintain composure, analyze situations objectively, and provide helpful assistance.
• Strong verbal & written communication.
• Ability to decipher resources for yourself and clients and know when to utilize other GBS departments.
• Must be able to effectively prioritize tickets and meet deadlines.
• Insurance / Claims / EOB knowledge highly recommended.
• Technically savvy and proficient with ongoing improvements in processes.
• Proven use and understanding of Microsoft Office.
• Spanish Preferred
• Performance Expectations:
• Ability to consistently attend work, meetings and training or staff events.
• Must work with respect and work well with diverse personalities.
• Must meet or exceed team and overall company expectations.
• Must work well independently as well as contribute to a team environment.
• Working Conditions / Essential Functions:
• Physical demands include the ability to lift and move objects (typically 0 - 10 lbs.) and visually monitor information/data on a computer screen.
• This job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee.

Benefits

Additional Information

Claims Specialist Department: Advocacy

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