Claims Specialist

Job Summary

Managing the end-to-end claims process for diagnostic laboratory services, the full-time remote Claims Specialist will ensure timely submission, follow-up, and resolution of insurance claims to maximize reimbursement and support the laboratory's financial health.

Key responsibilities

• Prepare, review, and submit claims for diagnostic lab services, ensuring compliance with payer guidelines
• Analyze denied claims to identify root causes and initiate corrective actions, including appeals and resubmissions
• Proactively follow up on outstanding claims and communicate with payers to expedite payment

Required qualifications

• Associate's or Bachelor's degree in healthcare administration, business, or related field (preferred)
• 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting
• Strong knowledge of insurance billing, payer requirements, and denial management
• Familiarity with laboratory coding (CPT, ICD-10) and remittance advice
• Proficiency with billing software and Microsoft Office Suite