Position Summary
Blue Water Benefits Administrators is seeking a knowledgeable, service-driven Adjuster / Customer Service Representative to support our health care administration operations. This role is responsible for processing medical claims, responding to member and provider inquiries via phone, email and chat, and ensuring benefits are applied accurately and consistently according to plan documents and company standards.
The ideal candidate is detail-oriented, analytical, and empathetic—someone who thrives in a fast-paced environment, enjoys problem-solving and is committed to delivering high-quality service to members, providers, and internal partners.
Key Responsibilities
Claims Processing & Investigation
- Process medical claims accurately and efficiently in accordance with plan documents and internal procedures
- Investigate claims to ensure correct benefit application and identify processing discrepancies
- Resolve inaccurate claim processing and document outcomes appropriately
- Request, review and follow up on additional information needed to determine benefits
Customer Service & Communication
- Respond to inquiries from members and providers via telephone, email and chat
- Clearly explain benefits, claim determinations and next steps in a professional and empathetic manner
- Prepare and send written correspondence to members and providers when additional documentation is required
- Serve as a knowledgeable resource for both internal teams and external partners
Compliance & Quality
- Ensure all work aligns with HIPAA requirements and BWBA compliance standards
- Maintain productivity, quality and service benchmarks
- Support quality initiatives and continuous improvement efforts
Qualifications & Experience
- 1–3 years of experience processing medical claims or working in health care administration
- Dental, vision or FSA claims experience a plus
- Strong understanding of claims workflows and benefit interpretation
- Excellent attention to detail and organizational skills
- Strong analytical, written and verbal communication abilities
- Ability to multitask and perform effectively in a high-volume environment
- Dependable attendance and professional work ethic
Preferred Attributes
- Service-oriented with a positive, empathetic communication style
- Calm, focused and solutions-driven under pressure
- Technically capable with a desire to grow in health care operations
- Team player who values accuracy, accountability and collaboration
Why Join Blue Water Benefits Administrators
Blue Water Benefits Administrators is a privately held, growing health care administrator committed to delivering exceptional service while fostering a collaborative, people-first culture. We offer:
- Competitive compensation
- Comprehensive benefits package
- Remote-friendly work environment
- Supportive, experienced leadership
- Long-term career growth opportunities within a stable healthcare industry