Claims Specialist

This is a fully remote position, open to applicants in Idaho, +5 more states.

📋 Description

• Timely and accurately resolve medical claims that are not automatically processed by the claims system.

• Investigate claims and communicate effectively to gather necessary information.

• Input data into the claims processing system.

• Analyze and interpret contract benefits.

• Conduct resolution of edits and audits.

• Assess benefit eligibility.

• Identify and research processing issues utilizing manuals and systems.

• Redirect claims to appropriate departments.

• Consult with internal staff and medical providers as needed.

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

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

• Access relevant computer systems and screens to ensure accurate claims processing.

• Stay updated on evolving processing procedures, benefits, and system changes.

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

• Utilize corporate and professional manuals and guidebooks, including processing manuals and ICD, CPT, and HCPS codebooks.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent.

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

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

• Proficient in both oral and written communication.

• Strong interpersonal skills.

• Demonstrated sound judgment.

• Decision-making capabilities.

• Detail-oriented approach.

• Ability to work effectively in a team environment.

• Dependability in completing tasks.

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

• Adhere to segregation of duties guidelines as outlined in the Administrative Manual.

🏝️ Benefits

• Opportunity to work from home in Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota.

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

• Preference will be given to current employees and candidates residing in Arkansas, Utah, Idaho, and North Dakota.