Claims Specialist

Job Summary

A company is looking for a Claims Specialist III responsible for capturing, resolving, and reporting on claim adjustment requests.

Key Responsibilities

• Resolve complex COB issues and maintain accountability for daily tasks and goals
• Process and adjust a variety of claims accurately and timely while identifying potential process improvements
• Act as a technical resource for training and ensure all provider issues are resolved within appropriate timeframes

Required Qualifications

• High School Diploma or equivalent is required
• A minimum of one (1) year of experience in a claims environment or related healthcare operations is required
• Previous experience in an HMO or related industry is preferred
• Previous Medicare/Medicaid dual eligible claims experience is preferred
• Experience in a Managed Care Organization or related healthcare industry is preferred