Health Insurance Specialist

Quantum Health seeks a Health Insurance Specialist to guide members through their coverage and care options. In this role, you'll answer benefit questions, explain plan details, resolve claim and billing issues, and coordinate with providers, health plans and employers. You'll document interactions, use internal tools to research eligibility and costs, and help members make informed, cost effective decisions. Working in our collaborative, mission-driven culture, you'll improve member experiences while growing your expertise in healthcare, insurance and customer service.

Responsibilities

• Guide members through health insurance benefits and coverage options
• Answer incoming inquiries regarding eligibility, costs, and network providers
• Explain plan details, prior authorizations, and out-of-pocket estimates in clear language
• Research and resolve claims, billing discrepancies, and benefit issues
• Coordinate with providers, health plans, and employer benefits teams to resolve cases
• Accurately document all member interactions and outcomes in internal systems
• Use internal tools and data to verify coverage and estimate costs
• Identify opportunities to improve member experience and escalate complex issues
• Maintain confidentiality and comply with HIPAA and other regulations
• Collaborate with team members in a fast-paced, mission-driven environment

Required Skills

• Health insurance plan navigation
• Benefits administration
• Medical billing and claims review
• Healthcare customer service
• Data entry and CRM usage
• HIPAA compliance knowledge
• Call center or case management systems
• Problem-solving and de-escalation
• Microsoft Office or similar productivity tools
• Basic analytics and reporting