Texas Licensed Medical Claims Specialist

Job Summary

Seeking a Texas Licensed Medical Claims Specialist, the full-time remote position will manage prior authorizations, insurance verifications, and assist with claims and denials while communicating with patients and healthcare providers.

Key responsibilities:

• Handle prior authorizations and verify patient insurance coverage
• Communicate with patients, healthcare providers, and insurance payers via phone and email
• Assist with claims processing, denials, and appeals while navigating multiple internal systems

Required qualifications:

• Minimum of 1 year of recent case management experience in a call center
• At least 1 year of recent medical insurance experience, including prior authorizations
• Experience with Medicare/Medicaid program administration and insurance verification
• High school diploma or equivalent
• Must currently reside in Texas