Claims Specialist II

To support the claims unit, the full-time Claims Specialist II will process claims edits, determine primacy for Coordination of Benefits (COB), adjust previously paid claims, and initiate recovery procedures for overpaid claims while working remotely. Key responsibilities Accurately process claims edits and adjust previously paid claims to ensure compliance with contractual benefits Analyze and resolve problem cases, including determining the correct order of benefits for payment and executing recovery processes Communicate with internal and external contacts to provide necessary information for sound claim records and customer satisfaction Required qualifications High School Diploma or equivalent required Minimum of 2 years of experience in medical claims processing Experience with Coordination of Benefits (COB) processing preferred Strong analytical skills with a focus on logical and investigative thinking Familiarity with relevant PC software applications