Claims Specialist

Job Summary

A company is looking for a Claims Specialist to work part-time from home.

Key Responsibilities:

• Adjudicate claims accurately and completely according to claims manual
• Process assigned claims for payment or denial following established procedures and guidelines
• Escalate claims issues or concerns to senior team members or management

Required Qualifications:

• 5+ years of experience adjudicating major medical health claims or in the healthcare industry
• 1-2 years recent experience supporting a health plan or health system
• Ability to recommend a likely diagnosis based on evidence such as patient statements, treatments provided, Rx prescribed, and healthcare provider notes
• Strong communication and organizational skills