Claims Specialist

Job Description

Job Description

Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ensuring timely reimbursement across commercial and workers’ compensation payers.

The ideal candidate is detail-oriented, proactive, and experienced in behavioral health billing workflows, including claim corrections, payer communication, and AR resolution. At this time, this position is 100% on-site in Irvine, CA and is not eligible for remote work.

Responsibilities:

• Claims Processing: Review and process incoming claims for accuracy, completeness, and compliance with policies and regulations.

• Claims Evaluation: Evaluate and assess the validity of claims based on established guidelines, reviewing medical records, police reports, and other relevant documentation.

• Claims Payment: Coordinate with the finance department to ensure timely and accurate claims payments.

• Investigation and Resolution: Investigate complex claims, including fraud prevention and risk analysis, and resolve any discrepancies or issues in a timely manner.

• Documentation: Maintain detailed and accurate records of claims processed, including all correspondence and supporting documentation.

• Compliance: Ensure all claims are processed in accordance with company policies, industry standards, and legal requirements.

• Reporting: Provide regular reports on claims status, processing times, and claim trends to management.

• Any other duties as assigned by department

Minimum Requirements:

• Experience: Minimum of 2-3 years of experience in claims processing or a related field.

• Knowledge: Understanding of insurance policies, claims procedures, and industry regulations.

Competencies:

• Detail-Oriented: Ability to carefully evaluate and manage claims with a high degree of accuracy.

• Problem-Solving Skills: Strong analytical and problem-solving skills to address and resolve issues in claims.

• Technical Skills: Proficiency in MS Office (Word, Excel, Outlook) and claims management software (e.g., Guidewire, VUE, etc.).

• Customer Service: Ability to deliver excellent customer service and resolve issues in a timely manner.

• Time Management: Strong organizational and time-management skills, with the ability to handle multiple tasks efficiently.