Claims Specialist

Strategic Staffing Solutions Has An Opening!This is a contract opportunity with our company that must be worked on a W2 only. No C2C eligibility for this position. Visa sponsorship is available! The details are below.Beware of scams. S3 never asks for money during its onboarding process.Job Title: Claims SpecialistRemote Work Contract Length: 5 MonthsJob Ref #: 247717The claims specialist will support claims operations by accurately processing claims edits, determining primacy for coordination of benefits, adjusting previously paid claims, and initiating procedures to recover funds on overpaid claims. This position will analyze, investigate, and resolve problem cases, execute recovery processes, and complete special projects while complying with applicable laws and regulations.Required QualificationsHigh school diploma or equivalentAt least 2 years of medical claims-processing experienceStrong analytical ability, including logical, systemic, and investigative thinkingStrong oral and written communication skillsStrong human-relations skillsWorking knowledge of relevant PC softwareAbility to prioritize multiple streams of work effectivelyPreferred QualificationsCoordination of benefits processing experienceHands-on experience determining which insurance plan pays first when a member has multiple sources of coverageExperience identifying primary and secondary coverageExperience reviewing and updating claims based on COB rulesExperience applying COB primacy rules, including subscriber status, effective dates, plan type, and Medicare coordinationExperience communicating with members, providers, and other insurers to verify coverage informationExperience correcting overpayments, initiating refunds or reprocessing claims, and maintaining accurate claim recordsExperience working within claims systems and following regulatory and compliance requirements, including HIPAAResponsibilitiesReview, research, and update claims, including recalculating benefits on previously processed claimsProcess claims edits according to contractual benefits and provider-reimbursement rulesInitiate refund requests when necessaryIdentify denial codes, edits, and processing codes associated with coordinated and non-coordinated claimsRequest medical records when requiredCommunicate orally and in writing with internal and external contacts to establish accurate claims recordsReview quality audits for correction or routing within 48 hours of receiptResearch and determine the correct order of benefits for payment by applicable plansMake necessary corrections to COB recordsNotify the appropriate departments when Medicare has determined primacy incorrectlyAnalyze, investigate, and resolve problem cases involving COB records, adjusted claims, and overpaymentsReview previously processed claims to ensure payment consistency and maximize overpayment recoveryExecute procedures to recover funds from providers, subscribers, or beneficiaries when overpayments occurSupport training, implementations, documentation, and special projectsAssist with matters involving internal-audit findings, provider-status changes, and system errorsPerform other job-related duties within the scope of the position