Claims Production Specialist

This is a fully remote position, open to applicants in Connecticut, +1 more state.

📋 Description

• Review and finalize medical claims, adjustments, and retractions in accordance with established policies and procedures.

• Investigate pending claims, research discrepancies, and collaborate with claims adjudication partners and vendors.

• Achieve productivity and accuracy targets.

• Identify unusual claims trends, processing variations, and potential issues, escalating findings to senior team members.

• Work together with Senior Claims Production Specialists, Finance, ASO, and external vendors to address claims issues and manage provider refunds.

• Handle incoming claims inquiries and requests within designated timelines.

• Uphold confidentiality and adhere to regulatory requirements.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare claims administration, medical claims processing, provider billing, or provider payment posting and reconciliation.

• High school diploma or equivalent qualification.

• Understanding of medical coding and billing methodologies, such as CPT-4, ICD-10, UB-04, and HCFA-1500.

• Familiarity with HIPAA, ACA, CMS, MassHealth, and ERISA regulations.

• Experience with claims processing systems, medical claims editing platforms, or medical pricing tools.

• Strong analytical, critical-thinking, and problem-solving abilities.

• Excellent communication and collaboration skills.

• Proficiency in Microsoft Word, Excel, and Outlook.

• A commitment to accuracy, confidentiality, compliance, and ongoing learning.

• Candidates must reside in Massachusetts or Connecticut.

🏝️ Benefits

• Full-time schedule, Monday through Friday, from 7:00am to 3:30pm.

• No weekend shifts.

• No holiday work required.

• Fully remote position available.