Claims Specialist

Job Overview

As a Claims Specialist supporting the healthcare revenue cycle operations, your primary responsibility will be to review, analyze, and process medical insurance claims. This includes working with denied claims, identifying root causes and following up for resolution. Your experience with healthcare claims (excluding dental, life, auto, pharmacy or DME) will be critical in ensuring accuracy and reimbursement.

Responsibilities

• Review and process denied medical insurance claims
• Investigate reasons for denials and follow up with payers to ensure resolution
• Apply knowledge of CPT/ICD codes and insurance guidelines to support claim adjudication
• Communicate with insurance companies, providers, and internal teams as needed
• Maintain accuracy and compliance with HIPAA and healthcare regulations
• Document claim activities and follow-ups in a timely and organized manner
• Collaborate with the billing and reimbursement teams to resolve issues impacting accounts receivable

Job Qualifications and Skills Set

• At least 1 year of experience handling medical claims and denial processing
• Familiarity with insurance terminology, claim workflows, and reimbursement procedures
• Average but effective communication skills (written and verbal)
• Detail-oriented and organized with strong analytical skills
• Experience in hospital or physician billing is a plus
• Proficient in relevant claims or EHR systems and basic MS Office tools