Claims Specialist
Pyramid Consulting•Austin, TX
•Remote
About The Position
The Claims Specialist supports the review and processing of appeals, disputes, and reconsiderations in accordance with established regulatory and accreditation guidelines. The role involves accurately entering and tracking data, preparing correspondence, maintaining documentation, researching claims, and helping ensure timely decisions. The specialist also gathers data on trends and outcomes and conducts outreach for updates as needed.
Requirements
- At least 2 years of healthcare claims and authorization experience, including claims review, provider appeals, denials, or reconsiderations.
- Strong data-entry skills, with a typing speed of 40 WPM and 90% accuracy.
- High school diploma or GED.
- Knowledge of appeals, disputes, and reconsideration processes.
- Experience in claims processing, utilization management, and medical billing/coding.
Nice To Haves
- Experience with TruCare and AMISYS.
Responsibilities
- Review and process appeals, disputes, and reconsiderations according to regulatory and accreditation guidelines.
- Enter data to track, log, and process appeals, maintaining a rate of 40 WPM with 90% accuracy.
- Prepare correspondence and maintain documentation files related to appeals and disputes.
- Research claims to evaluate them and provide effective responses in a timely manner.
- Gather data to track trends and final outcomes, and conduct outreach for updates as necessary.
- Comply with all policies and standards and perform other duties as assigned.
Benefits
- Health insurance, including medical, dental, and vision coverage.
- 401(k) plan.
- Paid sick leave, depending on work location.
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What This Job Offers
Education Level
High school or GED
