Claims Specialist

Claims Specialist Overview

• The Claims Specialist will manage and resolve claim disputes, ensuring compliance with regulations and service standards.
• This is a contract position with a duration of 60-90 days, with potential for extension.
• Work remotely with provided equipment, maintaining a 9 AM-5 PM schedule in your time zone.
• Gain experience with the No Surprises Act and Independent Dispute Resolution processes through comprehensive training.
• Collaborate with facilities and providers to negotiate claim settlements and facilitate reprocessing.
• Contribute to process improvements to streamline claim settlement procedures.
• Handle confidential information in compliance with HIPAA regulations.

Claims Specialist Key Responsibilities & Duties

• Maintain and manage an inventory of unpaid claims or claim disputes.
• Review and prioritize claims based on established processing criteria and timelines.
• Negotiate claim settlements with facilities and providers, drafting settlement agreements.
• Prepare offer submission letters for the Independent Dispute Resolution process.
• Document negotiation activities and outcomes, facilitating claims reprocessing.
• Participate in process improvement initiatives to enhance efficiency.
• Ensure compliance with HIPAA regulations while handling confidential information.

Claims Specialist Job Requirements

• High School Diploma or GED required; a Bachelor’s degree is preferred.
• Minimum of 2 years of experience in medical healthcare claims or a related field.
• Familiarity with the No Surprises Act and Independent Dispute Resolution processes is advantageous.
• Proficiency in using Google Workspace products and other relevant software.
• Strong organizational and communication skills to manage claim negotiations effectively.
• Ability to work independently in a remote environment with provided equipment.
• Commitment to maintaining confidentiality and adhering to HIPAA regulations.