Claims Specialist

Job Summary

Resolving medical claims that are not automatically adjudicated, the full-time remote Claims Specialist will ensure timely and accurate processing by investigating and communicating to obtain necessary information.

Key responsibilities

• Process pended claims by entering data, reviewing contract benefits, and determining benefit eligibility
• Maintain knowledge of processing procedures and stay current with changes to ensure compliance with corporate and national 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
• Must pass the company proficiency test: Claims Assessment
• Familiarity with medical terminology, anatomy, and claims processing
• Ability to access and utilize various computer systems effectively