Claims Specialist

This is a fully remote position, open to applicants in Idaho, +4 more states.

📋 Description

• Address medical claims that are not automatically processed by the claims system in a timely and precise manner while adhering to divisional quality and productivity benchmarks.

• Investigate claims and engage in communication to gather essential information for claim completion.

• Input data into the claims management system.

• Analyze and interpret contract benefits.

• Execute edit and audit resolutions.

• Assess benefit eligibility.

• Identify and investigate processing issues using systems and manuals.

• Direct claims to appropriate departments.

• Consult with internal personnel and medical providers.

• Produce correspondence and fill out forms to acquire necessary information.

• Complete initial training, on-the-job training, and ongoing education.

• Access relevant computer systems and interfaces to process claims correctly.

• Stay updated with evolving processing procedures, benefits, and system updates.

• Achieve corporate and national (MTM) standards while maintaining departmental productivity and quality metrics.

• Utilize corporate and professional manuals and guidebooks, including the company processing manual as well as ICD, CPT, and HCPCS codebooks.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School diploma or its equivalent.

• A minimum of two (2) years of college coursework (48 semester hours) or other equivalent certification focused on anatomy, medical terminology, math, biology, or a related discipline, OR at least one (1) year of relevant office experience such as claims processing, health insurance, or medical office work.

• Must successfully complete the company proficiency test: Claims Assessment.

• Proficient in oral and written communication.

• Strong interpersonal abilities.

• Demonstrated sound judgment.

• Effective decision-making skills.

• Detail-oriented approach.

• Strong teamwork capabilities.

• Dependability in all tasks.

• Must ensure the security and confidentiality of records and information.

• Compliance with segregation of duties guidelines outlined in the Administrative Manual.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with company matching.

• Paid time off and holiday leave.

• Professional development opportunities.

• Employee assistance programs.