Medical Claims Specialist

Job Summary

A company is looking for a Medical Claims Specialist to review, evaluate, and process claims in accordance with policy provisions and regulatory requirements.

Key Responsibilities

• Review and analyze claim submissions and supporting documentation
• Determine claim eligibility and calculate payment amounts
• Maintain organized claim files and communicate decisions to stakeholders

Required Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree preferred
• 2+ years of claims processing or insurance industry experience preferred
• Strong knowledge of claims adjudication procedures and regulatory requirements
• Proficient in claims management software and Microsoft Office Suite
• Experience with analytical thinking and decision-making