Claims Specialist

Job Summary

Supporting medical claims operations, the remote contract Claims Specialist II will research, analyze, and process claims with a focus on Coordination of Benefits (COB), ensuring accurate benefit calculations and compliance with regulations.

Key Responsibilities

• Review, research, and process medical claims and claim adjustments
• Analyze and resolve claims edits, denials, and payment discrepancies
• Determine the correct order of benefits when multiple insurance plans are involved

Required Qualifications

• High School Diploma or equivalent
• Minimum of 2 years of medical claims processing experience
• Experience researching and resolving claim issues
• Strong analytical and investigative skills
• Proficiency with Microsoft Office and claims processing systems