Claims Specialist

Job Summary

Resolving medical claims that are not automatically adjudicated, the full-time Claims Specialist will work remotely to ensure timely and accurate claim resolutions while adhering to divisional quality and productivity standards.

Key responsibilities

• Process pended claims by entering data, reviewing benefits, and determining eligibility
• Stay updated on processing procedures and maintain knowledge of relevant systems and coding standards
• Perform additional duties as assigned to support the claims processing team

Required qualifications

• High School diploma or equivalent
• Minimum two years of college coursework in a relevant field or one year of related office experience
• Ability to pass the company proficiency test: Claims Assessment
• Familiarity with medical terminology and claims processing procedures
• Commitment to maintaining the security and confidentiality of records and information