Claims Production Specialist

Job Summary

Detail-oriented and dedicated, the full-time Claims Production Specialist will support accurate and timely processing, adjustment, recovery, and finalization of medical claims while working remotely from Massachusetts or Connecticut.

Key responsibilities

• Review and finalize medical claims, adjustments, and retractions in accordance with established policies and procedures
• Investigate pending claims, research discrepancies, and coordinate with claims adjudication partners and vendors to resolve issues
• Meet productivity and accuracy goals while helping the team deliver consistent, high-quality results

Required qualifications

• 3+ years of experience in healthcare claims administration, medical claims processing, provider billing, or provider payment posting and reconciliation
• High school diploma or equivalent
• Knowledge of medical coding and billing methodologies, including CPT-4, ICD-10, UB-04, and HCFA-1500
• Familiarity with healthcare regulations and payer requirements, including HIPAA, ACA, CMS, MassHealth, and ERISA
• Experience with claims processing systems, medical claims editing platforms, or medical pricing tools