Claims Process Specialist

Job Summary

A company is looking for a Claims Process Specialist (remote).

Key Responsibilities

• Review and process claim submissions according to guidelines, ensuring compliance with regulations
• Determine payment approvals, pending claims, or denials based on coverage guidelines
• Maintain customer relations by addressing claims issues and updating claim information as needed

Required Qualifications

• High School diploma or GED required
• Minimum of two to three years of Medicaid and/or Commercial claims processing experience
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, and UB92 Codes
• Proficient in Microsoft Office applications and experience navigating multiple systems
• Ability to work remotely in a secure environment with high-speed internet access