Claims Specialist
About The Position
We’re looking for a detail-oriented Claims Specialist to join our team. This role is a great fit for someone who understands healthcare claims, enjoys solving problems, and takes pride in helping members and healthcare providers navigate the claims and reimbursement process. As a Claims Specialist, you’ll review and process medical, dental, and vision claims while helping ensure claims are handled accurately and reimbursements are completed in a timely manner. You’ll work closely with members, healthcare providers, and internal teams to research claim issues, resolve discrepancies, and provide clear information about claim and reimbursement requirements.
Requirements
- Experience in claims and/or billing
- Understanding of medical terminology
- Basic knowledge of healthcare concepts including network status, reference base pricing / UCR, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, and plan variations
- ICD-10, CPT, HCPCS, CDT knowledge
- Basic understanding of coordination of benefits
- Excellent communication skills
- Must be a team player yet able to work independently
- Attention to detail
- Ability to multi-task and prioritize
Nice To Haves
- Knowledge of appeal and subrogation is preferred
Responsibilities
- Review and process medical, vision, and dental claims.
- Maintain a clear understanding of all current plans and their benefit features.
- Maintain required productivity and quality standards.
- Identify process improvement opportunities.
- Send and track medical record requests.
- Communicate with healthcare providers and members around claim and reimbursement status and requirements.
- Maintain accurate records of claims and reimbursements.
- Identify and correct discrepancies in claims.
- Send and track provider refund requests.
- Ensure timely reimbursement for services.
- Monitor claim status and follow up on outstanding claims.
- Serve as a backup for clerk tasks during employee absences.
- Answer questions and provide resources to different team members.
- Other duties as assigned.
Benefits
- 12 paid holidays
- 3 weeks of paid time off
- Comprehensive insurance coverage including health, dental, vision, and accident plans
- Free membership for you and your dependents to Primestin Care Clinic
- 401k plan
- Free snacks and regular lunches available onsite
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
