Insurance Specialist

Quadax Careers & Culture • Middleburg Heights, OH

5d

About The Position

The Insurance Specialist will be responsible for following up on claim status via insurance portals or calls to payers to determine adjudication and details. This role involves calling payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage. The specialist will also verify patient insurance eligibility and coordination of benefits, review and analyze payer correspondence, and investigate electronic claim rejections. Additionally, they will submit claims for processing corrections, to secondary insurances, or to updated addresses, and research requests for insurance payment retractions. The role requires monitoring and notifying management of payer trends and/or claim processing issues, and meeting or exceeding productivity and quality KPI goals. Other duties may be assigned.

Requirements

• High School diploma or GED
• Previous health insurance billing experience
• Working knowledge of medical terminology
• Strong problem-solving skills and the ability to adapt to changes in policies, regulations, and procedures
• Excellent written and verbal communication skills
• High attention to detail
• Ability to interact effectively with others
• Ability to maintain confidentiality
• Proficient computer skills with knowledge of Microsoft Word and Excel

Responsibilities

• Follow up on claim status via insurance portals or calls to payers to determine adjudication and details.
• Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage.
• Verify patient insurance eligibility and coordination of benefits.
• Review and analyze payer correspondence.
• Investigate electronic claim rejections.
• Submit claims for processing corrections, to secondary insurances, or to updated addresses.
• Research requests for insurance payment retractions.
• Monitor and notify management of payer trends and/or claim processing issues.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED