Ultimate Staffing ยท 1 day ago
Participant Service Specialist
Burbank, CA
Full-time
Onsite
Mid, Senior Level
$55K/yr - $65K/yr
4+ years expUltimate Staffing is seeking a customer-focused Senior Participant Service Specialist / Analyst to support health insurance claims processing and high-volume customer interactions. This role serves as a frontline resource for participants, providers, and healthcare partners, while also contributing to business process analysis and continuous improvement initiatives.
EmploymentHuman ResourcesManufacturingStaffing Agency
Hiring Manager
Serena Moreno
Responsibilities
Process and review health insurance claims for accuracy, eligibility, pricing, and benefits
Handle a high volume of inbound calls related to benefits, eligibility, billing, authorizations, and explanations of benefits (EOBs)
Resolve customer inquiries by researching issues, interpreting policy guidelines, and applying appropriate solutions
Document interactions and claims activity accurately in real time across multiple systems
Ensure compliance with claims policies, federal mandates, and benefit plan documentation
Meet performance standards for quality, productivity, accuracy, and customer satisfaction
Train and support new team members as needed
Partner with internal teams to improve workflows, documentation, and customer experience
Analyze business processes, identify gaps, and recommend improvements
Develop and maintain process documentation, policies, and workflows
Evaluate impacts of system enhancements and regulatory changes
Research benefit and service trends to support operational improvements
Qualification
Required
4+ years of experience in a high-volume call center environment
Strong knowledge of benefit plans, claims processing, and medical terminology
Excellent problem-solving, communication, and customer service skills
Proficient in Microsoft Word, Excel, and Outlook
Ability to manage multiple priorities in a fast-paced environment
Reliable, organized, and adaptable with strong decision-making skills
Preferred
Bachelor's degree in Healthcare, Mathematics, Engineering, or related field (or equivalent experience)
4+ years of health insurance claims processing experience
Company
Ultimate Staffing
Ultimate Staffing specializes in clerical, administrative, customer service, and manufacturing and production positions.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Lisa Marez
Partnership Director
Company data provided by crunchbase