Claims Specialist

Job Summary

A company is looking for a Claims Specialist-4 to process and resolve complex claims issues.

Key Responsibilities

• Process and research complex claims and adjustments to ensure accurate adjudication
• Assist partner departments with escalated claims issues and contribute to quality and production standards
• Participate in process improvement initiatives and serve as a subject matter expert for documentation and projects

Required Qualifications

• High school diploma or equivalent; associate's degree or equivalent business experience preferred
• 2-4 years of experience in claims processing or customer service in a healthcare environment required
• Knowledge of medical coding guidelines (CPT, ICD-9/ICD-10, HCPCS) and billing forms (CMS1500 & UB04)
• Understanding of Coordination of Benefits (COB) and Third-Party Liability (TPL) claims regulations
• Proficiency in Microsoft Office applications and familiarity with internal claims processing applications preferred