Texas Licensed Clinical Claims Specialist

Job Summary

A company is looking for a Complex Claims Specialist to improve and manage complex and catastrophic claims.

Key Responsibilities

• Provide explanations of disease states and associated costs to stakeholders
• Consult with underwriting on medical care approaches and standards
• Review claims and clinical documents to enhance member care and reduce costs

Required Qualifications

• Licensure as a RN or Bachelor's in Healthcare Management or related field
• A minimum of 5 years of clinical/risk management experience
• Experience and/or knowledge of health insurance processes
• CCM, NANCM, or other relevant certification is a plus
• Working knowledge or experience in quality and care management