Policy Support Specialist

Job Summary

Reviewing medical policies and preparing cases for clinical review, the full-time Policy Support Specialist will manage claims processing and service requests while working remotely.

Key responsibilities

• Research member medical records to resolve claims or service requests pending clinical edits
• Coordinate the clinical review and appeal processes, including preparing cases and requesting additional information
• Review and determine pricing for clinical claims in accordance with negotiated pricing agreements

Required qualifications

• Minimum of a High School Diploma or GED equivalent required
• Three (3) years of health care claims processing experience
• Two (2) years of experience with medical terminology, billing, and coding
• Knowledge of Coordination of Benefit (COB) and medical policies preferred
• Familiarity with all lines of business preferred