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 wide variety of claims accurately and timely
• Act as a technical resource for training and assist providers with inquiries related to claims

Required Qualifications

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