Claims Specialist

Job Title: Claims Specialist

Job Type: Full-Time, Remote

Working Hours: US Hours (9am-5pm EST)

Key Responsibilities

• 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.

Requirements

• 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.

Benefits

1. Comfortable working U.S. hours
2. Remote work from home

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