Claims Specialist

Job Summary

Resolving medical claims that require additional investigation, the full-time Claims Specialist will work remotely to ensure timely and accurate adjudication of claims not automatically processed by the system.

Key responsibilities

• Process and resolve pended claims by entering data, reviewing benefits, and determining eligibility
• Stay current with processing procedures and maintain knowledge of relevant coding and corporate standards
• Perform additional duties as assigned, including training and continuous education on claims processing

Required qualifications

• High School diploma or equivalent
• Minimum two years of college coursework or one year of related office experience in claims processing or health insurance
• Must pass company proficiency test: Claims Assessment
• Knowledge of anatomy, medical terminology, and related fields is preferred
• Ability to access and utilize relevant computer systems for claims processing