Sr Claims Specialist
About The Position
The Finance Department is a team of professionals that are tasked with functions including capital and debt planning, investments, accounting, payroll, procurement, grant management and payables along with providing additional fiscal support to departments across the County. The Ideal candidate will perform professional and complex accounting work involving the preparation and/or maintenance of financial or related records. This position, under minimal supervision, is responsible for establishing and maintaining financial records which may include budgets, expenditures, and revenues. Prepare, review, analyze, and submit a variety of complex and/or special reports, reconciliations, work papers, communications, schedules, tables, and/or statements to and from internal departments, financial institutions, and external agencies. Mecklenburg County is excited to welcome a Senior Claims Specialist to our Finance Department. This role serves as the team lead level authority within the revenue cycle function, overseeing the execution of complex claims and collection activities while guiding and developing the Claims team. In addition to handling high level insurance appeals (Levels 2–5), this role will drive process optimization, evaluate denial trends, and conduct A/R analyses that inform budget planning and fiscal year projections. The selected candidate will be accountable for ensuring quality, compliance, training, and continuous improvement across all claims workflows and for translating operational insights into strategic recommendations for leadership.
Requirements
- 5+ years of progressive experience in medical claims, billing, or revenue cycle operations, including experience with complex/multi-level appeals
- Associate's or Bachelor's degree in Healthcare Administration, Business, Finance, or a related field (or equivalent experience)
- Strong working knowledge of payer requirements, coding compliance, and appeal processes (Level 2–5) for private and government payers
- Advanced analytical skills, including denial trend analysis and A/R/KPI reporting
- Demonstrated ability to develop and improve operational processes and SOPs
- Strong leadership, coaching, and training capabilities
- Excellent judgment and decision-making for day-to-day operational issues
- Proficiency with claims/financial management systems and reporting tools
- Ability to work collegially across departments and respond efficiently under pressure
Nice To Haves
- Extensive experience mentoring, training, or informally leading a team highly preferred
Responsibilities
- Provide oversight of claim submission quality and accuracy across all programs and payer types
- Monitor coding compliance and provide ongoing staff education to maintain adherence to standards
- Provide oversight into any payment posting and reconciliation to ensure accuracy of financial records
- Maintain and update standard operating procedures (SOPs) and workflow documentation
- Serve as liaison with clinical departments to drive documentation improvement that supports clean claims
- Personally manage and resolve complex, escalated appeals (Level 2–5) for private health care and government payer denials
- Analyze denial patterns to identify root causes and implement corrective process improvements
- Develop, implement, and continuously refine collection protocols and escalation best practices
- Coordinate insurance follow-up activity and manage escalation pathways for aged or high-risk accounts
- Oversee monitoring of past-due accounts and ensure appropriate handling per uncollectible account policy
- Ensure day-to-day operations run efficiently and maintain quality standards
- Train and mentor Claims Specialists on technical claims processes, tools, and best practices
- Develop training materials and act as a subject-matter resource for internal departments, financial institutions, and external agencies
- Coach team members on quality standards and support their professional development
- Produce A/R analytics and denial-pattern analysis to support budget and fiscal-year forecasting
- Gather and analyze financial trends to identify gaps and inform budget and fiscal-year projections
- Participate in special projects related to revenue cycle and financial performance initiatives
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
