CLAIMS REVIEW SPECIALIST

State of Arkansas•Little Rock, AR

About The Position

The Department of Human Services is a place for people passionate about serving others and changing lives for the better. We care for Arkansans of all ages and ensure places like child care centers and nursing homes are safe. We are the safety net for the most vulnerable Arkansans. Whether you answer the phones, take applications, protect children, or help care for residents or patients at one of our facilities, you make a difference by working at DHS. Plus, working for the State has great perks, including a pension, maternity leave, paid state holidays, and much more. At DHS, we take care of our employees so you can help care for others. Position InformationJob Series: Program Operations – Claims ReviewClassification: Claims Review SpecialistClass Code: PCR02PPay Grade: SGS03Salary Range: $39,171 – $57,973Job SummaryThe Claims Review Specialist plays a critical role in supporting the insurance claims process by reviewing and evaluating claims for accuracy, completeness, and compliance with pre-determined agency policies and regulatory standards. This classification involves verifying claim documentation, investigating discrepancies, and ensuring the timely and efficient resolution of claims.

Requirements

High school diploma or GED.
Two years of experience in clerical or administrative functions.
Strong analytical and problem-solving skills, attention to detail, good written and verbal communication.
Willingness to learn and adapt to new tools, technologies, and processes.
Experience with using standard office software (e.g. Microsoft Excel, Word).
A proactive and team-oriented approach to work.
Familiarity with department related programs.

Responsibilities

Assess insurance claims to ensure all required information is accurate and complete.
Verify claim documentation against policy terms and conditions.
Identify missing or inconsistent information and coordinate with the appropriate personnel to resolve issues.
Document findings and actions taken for each claim in an organized manner.
Communicate claim outcomes and provide necessary explanations to policyholders or internal personnel.
Support fraud detection and prevention efforts by reporting unusual patterns or inconsistencies.
Stay informed on agency policies, industry practices, and relevant regulations.
Collaborate with senior team members and managers to improve claims processing workflows.