Benefits & Claims Specialist, PACE Program, Full-time

Under the supervision of the VP of Finance and the Executive Director, the Benefits and Claims Specialist assists participants and families throughout the Medicaid application process and maintains accurate logs of Medicaid eligibility.

The role is responsible for day‑to‑day claims processing and adjudication activities while providing support to vendors and internal teams.

As the team lead for the claims processing function, this position also contributes to workflow development, process improvement initiatives, and applies advanced technical expertise to support complex claims scenarios.

Additionally, the role assists Medicaid Representatives with challenging situations, which may include meeting with participants, families, social workers, and county personnel.

• Associate’s degree in Finance, Business, or Healthcare Administration
• Knowledge of Medicaid system and benefits
• 3 Years of Medical Claim Adjudication/Processing Experience
• 1 Year of PACE Specific Medical Claim Processing Experience
• Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
• Be medically cleared for communicable diseases and have all immunizations up to-date before engaging in direct participant contact.