The HT Group has an insurance client in Austin, TX looking for a
Claims Eligibility Specialist who is experienced, detail-oriented, and customer-focused to review and manage claims of varying complexity. This is a great opportunity for someone looking to grow within a dynamic and mission-driven environment.
This role offers flexible work options-hybrid (3 days in office) if the candidate is in Austin, TX or fully remote. Only candidates with LVN, LPN, LSW certification/license will be considered.
Hybrid/Remote
$65,000-$75,000
Direct-Hire
Monday-Friday 8AM-5PM CST
Responsibilities:
- Investigate and evaluate claims for coverage and eligibility
- Analyze relevant documents to support claim decisions
- Establish appropriate Plans of Care based on company guidelines
- Manage short-term and limited approval claims
- Assist with customer complaints and appeals
- Communicate complex claim decisions and coverage details to stakeholders
- Ensure compliance with legal and company claims-handling procedures
- Provide guidance to junior staff and support team leads when needed
Requirements:
- 5+ years of experience in claims management and review, preferably in the insurance industry
- LVN, LPN, LSW certification/license required
- Strong technical knowledge of claims processing and policy evaluation
- Excellent verbal and written communication skills, with empathy and professionalism
- Ability to work independently with minimal supervision
All qualified applicants may apply below or send an email to