Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries
Determine whether any claim payment or denial issues are present
Submit the necessary documents to specific areas to ensure all is updated and corrected
Submit all projects and/or claims to be reprocessed
Perform education for providers, both internal and external, when required
Attend provider group meetings, as well as individual meetings, both internally and externally
Submit projects within Microsoft Excel as assigned
Perform other duties as needed

1-3 years of medical claims experience
1-3 years of intermediate Excel experience with demonstrated proficiency in formulas, pivot tables and vlookups
Must reside in Florida
Bilingual in English/Spanish (preferred)
2+ years of provider claims experience (preferred)
Certified Professional Coder (CPC) (preferred)
Knowledge of provider billing, particularly with professional and hospital claims (preferred)
Strong attention to detail
Excellent communication, collaboration, and relationship building skills
Self-motivated and ability to drive independent work
Strong writing and documentation skills

Senior Claim Data Specialist, Provider Claims

Key skills