West Virginia Licensed Claims Specialist

Job Summary

A company is looking for a Medical Claims Specialist - Remote WV.

Key Responsibilities

• Review and analyze claims, documentation, and policy details to determine eligibility, coverage, and benefits
• Request additional information and ensure claims meet company policies and regulatory standards
• Calculate and authorize accurate claim payments while maintaining detailed records

Required Qualifications

• High school diploma required; Associate's or Bachelor's degree preferred
• Two or more years of experience in claims processing or the insurance industry preferred
• Strong understanding of claims adjudication processes, policies, and regulatory standards
• Proficient in claims management systems and Microsoft Office applications