Louisiana Licensed Claims Specialist II
Job Summary
Detail-oriented and experienced in medical claims, the remote Claims Specialist II will manage complex claims processing with a focus on Coordination of Benefits (COB), ensuring compliance with healthcare regulations while resolving issues and recovering overpayments.
Key responsibilities
- Process and adjust medical claims, determining primary and secondary insurance coverage based on COB rules
- Research and resolve complex claims issues, payment discrepancies, and initiate recovery efforts for overpayments
- Communicate with providers, members, and insurance carriers to verify coverage and ensure accurate claim adjudication
Required qualifications
- High School Diploma or equivalent
- Minimum 2 years of medical claims processing experience
- Strong understanding of healthcare claims adjudication and reimbursement
- Proficiency with Microsoft Office and healthcare claims systems
- Excellent analytical and investigative skills
Complete Job Description
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