Process and adjudicate insurance claims according to company policies and regulations, ensuring accuracy and compliance.
Review and analyze claims to identify any discrepancies or issues requiring resolution.
Communicate with insurance companies, healthcare providers, and patients to address claims-related inquiries and disputes.
Collaborate with internal teams to gather necessary documentation and information to support claim decisions.
Maintain detailed records of claims activity and ensure timely follow-up on outstanding claims.
Stay updated on industry changes and payer policies to optimize claims processing and reimbursement rates.

Associate's degree in healthcare administration, business, or a related field; Bachelor's degree preferred.
Minimum of 2 years of experience in claims processing or a related role in the healthcare industry.
Strong understanding of medical terminology, coding (CPT, ICD-10, HCPCS), and insurance policies.
Excellent analytical skills with keen attention to detail.
Proficient in claims management software and electronic health record (EHR) systems.
Strong communication skills, both verbal and written, for effective interaction with stakeholders.
Able to work independently in a remote setting and manage time effectively to meet deadlines.

Claims Specialist

Key skills