Claims Coordinator

You are a bilingual professional fluent in both English and Spanish, with strong communication skills and a keen attention to confidentiality and time management. You bring related experience and a high school diploma or equivalent, along with the ability to quickly learn new processes and work independently with minimal supervision.

You thrive in a fast-paced environment where you handle customer inquiries with accuracy and professionalism. You are proactive in investigating issues, collaborating with cross-functional teams, and providing timely updates to both customers and management. Your detail-oriented approach helps identify potential fraudulent claims, and you are comfortable supporting special projects and participating in team meetings and training.

If you’re a motivated self-starter who enjoys delivering exceptional customer service and contributing to an efficient claims process, you’ll be a great fit for this role.

The Claims Coordinator handles inquiries and concerns related to claims, including coverage details, benefit limits, explanation of denials, and payment status. This role is responsible for receiving, responding to, and directing phone calls and other communications from members, brokers, and providers—ensuring accurate information is provided promptly and escalating issues when necessary.

• Receive and handle customer inquiries from potential, current, and former members, brokers, and providers.

• Provide timely, accurate, and clear information in response to customer requests.

• Process customer requests following established departmental policies and procedures.

• Conduct research and investigations to resolve customer inquiries effectively.

• Collaborate closely with claims adjudicators and other departments to gather necessary information.

• Deliver timely feedback to customers through outbound calls, emails, mail, or fax.

• Identify potential fraudulent claims and take appropriate action in line with company protocols.

• Assist with client office visits as needed.

• Report service failures, systemic issues, and customer concerns promptly to the Claims Director or Claims Manager.

• Generate reports for brokers to facilitate the completion of claims and payment processes.

• Support the completion of special projects as assigned.

• Attend and actively participate in meetings and training sessions as required.

• Perform other duties as assigned.

• High school diploma or equivalent required

• Related experience preferred

• Fluent in English and Spanish

• Strong confidentiality and time management skills

• Ability to learn quickly and work independently with self-motivation

At VUMI®, the well-being of our employees is our top priority. We offer a robust benefits package that includes:

• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Hybrid Work Model (combination of remote and in-office work)
• Wellness Programs, including free access to our building gym
• A vibrant, engaging work environment that values and supports our employees’ growth, well-being, and success

The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

Work Environment:

The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain.

Physical Demands:

The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to:

• exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
• operate standard office equipment such as copiers, computers, telephones, printers, etc.

Travel Requirements:

Minimal to no travel required

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.