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 processing while adhering to divisional quality and productivity standards.

Key responsibilities

• Process pended claims by entering data, reviewing contract benefits, and determining benefit eligibility
• Conduct ongoing training and stay updated on processing procedures, benefits, and system modifications
• Perform additional duties as assigned, ensuring compliance with corporate standards and guidelines

Required qualifications

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