Louisiana Licensed Claims Specialist

Job Summary

To support the claims unit, the full-time Louisiana Licensed Claims Specialist will accurately process claims edits, determine primacy for Coordination of Benefits (COB), adjust previously paid claims, and initiate procedures to recover funds on overpaid claims in a remote work environment.

Key responsibilities

• Review and update claims, including recalculating benefits and processing claims edits to ensure customer satisfaction
• Communicate with internal and external contacts to provide accurate information for establishing sound claim records
• Research and determine the correct order of benefits for payment, making necessary corrections to COB records

Required qualifications

• High School Diploma or equivalent required
• 6 months of experience in medical claims or health insurance-related customer service, or completion of relevant training
• Certification in Medical Billing or Coding can substitute for experience
• Strong analytical skills and working knowledge of relevant PC software