Claims Specialist I

Job Summary

Resolving medical claims that require manual adjudication, the full-time remote Claims Specialist I will ensure timely and accurate processing of claims while managing additional investigations and communications as needed.

Key responsibilities

• Process and resolve pended claims by entering data, reviewing contract benefits, and determining benefit eligibility
• Stay current with processing procedures, benefits, and system modifications through ongoing training and education
• Perform additional duties as assigned, ensuring adherence to corporate and national standards for quality and productivity

Required qualifications

• High School diploma or equivalent
• Minimum two years of college coursework (48 semester hours) in anatomy, medical terminology, math, biology, or a related field, or one year of related office experience
• Must pass company proficiency test: Claims Assessment
• Demonstrated ability to access and utilize relevant computer systems for claims processing
• Familiarity with corporate processing manuals and coding systems such as ICD, CPT, and HCPS