Claims Research Specialist

Job Summary

A company is looking for a Claims Research Specialist to act as a liaison for claims inquiries and resolutions.

Key Responsibilities

• Investigate and resolve internal and external claims-related issues
• Assist with data integrity of the provider claims processing system and educate stakeholders on policies
• Review Medicaid Bulletins for updates and manage provider complaints regarding claims issues

Required Qualifications

• High school diploma or equivalent; Bachelor's degree preferred
• 3+ years of experience in claims payment processing in government programs
• Experience in a managed care environment
• Knowledge of claims billing and processing functions and Medicaid benefits
• Customer service experience is a plus