Claims Specialist

Job Summary

To support the claims adjudication process, the full-time remote Claims Specialist will manage the end-to-end claims review, including verifying eligibility, auditing claims for accuracy, and ensuring compliance with state and federal regulations.

Key responsibilities

• Review and process claims according to plan benefits and contractual reimbursement terms
• Audit auto-adjudicated and manually processed claims for accuracy and compliance
• Develop and maintain desktop procedures related to claim adjudication

Required qualifications

• Minimum of 3 years of medical claim adjudication or examination experience
• Knowledge of medical and insurance terminology, including CPT/ICD-10 and HCPCS codes
• Experience writing desktop procedures
• Proficiency in Microsoft Office applications
• Prior experience with claim testing and auditing