Oregon Licensed Healthcare Claims Specialist

Job Summary

A company is looking for a Healthcare Claims Appeals Specialist (Remote).

Key Responsibilities

• Manage the full lifecycle of provider billing disputes and appeals
• Review claims, coding, medical policies, contracts, and regulatory requirements to develop appeal recommendations
• Coordinate with clinical reviewers and partners to ensure timely resolution of complex cases

Qualifications

• Minimum 4 years of experience in healthcare claims, appeals, or related fields
• Strong knowledge of medical terminology and coding, with coding certification preferred
• Demonstrated analytical skills with the ability to interpret complex policies
• Proficiency with Microsoft Office tools and experience in healthcare-related systems