Claims Specialist

Job Summary

A health plan is looking for a Claims Specialist.

Responsibilities:

• Execute the process of adjudicating claims with accuracy and completeness as defined in the claims manual
• Process assigned claims for payment or denial in accordance with established procedures and guidelines
• Escalate claims issues or concerns to senior team members and/or management

Qualifications:

• 5+ years of experience adjudicating major medical health claims
• 1+ year of 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