Claims Specialist

ASK Consulting LLC

Durham, NC

Description

Job Title: Claims Specialist

Location: 100% Remote

Duration: 6-Month Contract

Pay Rate: $18.00 - $20.94/hour on W2

Job Summary

We are seeking an experienced Claims Specialist to join our team for a 6-month contract opportunity. The ideal candidate will have experience processing Local Insured and ASO Commercial Claims , reviewing Medicare claims, working with Facets , and ensuring accurate and timely claims adjudication.

Key Responsibilities

Process, adjust, and update moderate to complex medical claims and payment corrections.
Review and adjudicate Medicare, Local Insured, and ASO Commercial claims.
Review DTPs and process claims using Facets .
Research suspended claims by reviewing eligibility, claims history, benefits, and related documentation.
Respond promptly to inquiries from customer service representatives, providers, physicians, members, and insurance carriers regarding claims and payment issues.
Escalate complex claims requiring specialized review in accordance with department guidelines.
Coordinate with Medicare and other insurance carriers to determine payment liability.
Identify system issues, document findings, and recommend solutions to technical support teams.
Partner with Provider Services to resolve provider-related claim issues.
Identify potential fraud or abuse and refer cases to the Special Investigations Unit (SIU).
Maintain established quality and performance standards.
Contribute to continuous process improvements and share best practices.
Participate in departmental and enterprise projects as needed.

Required Qualifications

High School Diploma or GED.
Minimum 3 years of healthcare claims processing experience .
Experience with Local Insured and ASO Commercial Claims ( Required ).
Experience processing Medicare claims .
Experience reviewing DTPs .
Hands-on experience using Facets .
Strong analytical, problem-solving, and communication skills.
Ability to work independently in a fast-paced environment while maintaining accuracy and quality.

Apply

Vacancy posted 3 days ago

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