Texas Licensed IDR Claims Specialist

Job Summary

To support the resolution of out-of-network billing disputes, the remote Texas Licensed IDR Claims Specialist will analyze, organize, and prepare claims documentation for submission to the Texas Department of Insurance and Federal Independent Dispute Resolution entities while ensuring compliance with regulatory and internal requirements.

Key responsibilities:

• Analyze and prepare claims documentation for IDR cases, ensuring accurate tracking and submission
• Perform claim adjustments based on final determinations from negotiation, mediation, or arbitration
• Collaborate with Claims, Provider Disputes, and external stakeholders while maintaining confidentiality and data integrity

Required qualifications:

• High School Diploma or GED
• 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment
• Experience researching, reviewing, and processing medical claims
• Proficiency with Microsoft Office Suite and spreadsheet tracking
• Ability to interpret claim data and supporting documentation accurately