Claims Specialist I

Job Summary

Resolving medical claims that are not automatically adjudicated, the full-time remote Claims Specialist I will ensure timely and accurate claim processing by conducting investigations and communicating with necessary parties to gather information.

Key responsibilities

• Process pended claims by entering data, reviewing contract benefits, and determining benefit eligibility
• Stay current with processing procedures and maintain knowledge of relevant computer systems and coding manuals
• Perform additional duties as assigned to support overall claims processing operations

Required qualifications

• High School diploma or equivalent
• Minimum two years of college coursework or equivalent certification in a related field
• At least one year of related office experience in claims processing or health insurance
• Must pass company proficiency test: Claims Assessment
• Familiarity with ICD, CPT, and HCPS codebooks is preferred