Claims Specialist (278635)

Job Description

Job Description

"All candidates must be directly contracted by ASK Consulting on their payroll and cannot be subcontracted. We are unable to provide sponsorship at this moment".

Job Title: Claims Specialist

Location: Durham, NC 27707

Duration: 6 months 

Pay Range is $18-$20/hr on W2

Job Summary:

We are seeking an experienced  Claims Specialist to join our healthcare operations team. In this role, you will review, process, adjust, and resolve medical insurance claims while ensuring accuracy, compliance, and timely payment. You will collaborate with internal teams, healthcare providers, members, and other insurance carriers to research claim issues, determine payment liability, and provide excellent customer service. The ideal candidate will have experience with healthcare claims processing, Medicare coordination, eligibility verification, and claims resolution in a fast-paced environment.

Key Responsibilities:

• Review, process, adjust, and update moderate to complex healthcare claims and payment corrections.
• Investigate and resolve suspended claims by reviewing member eligibility, benefits, claims history, and supporting documentation.
• Respond to inquiries from customer service representatives, members, providers, physicians, and other insurance carriers regarding claims status and payments.
• Research and resolve claims discrepancies while ensuring compliance with company policies and healthcare regulations.
• Escalate complex claims to subject matter experts when specialized review or resolution is required.
• Coordinate with Provider Services and other internal departments to resolve provider-related claim issues.
• Work with Medicare and other insurance carriers to determine primary and secondary payment responsibility.
• Identify potential fraud or abuse and refer suspicious claims to the Special Investigations Unit (SIU) for further review.
• Document system issues, recommend improvements, and communicate findings to technical support teams.
• Maintain accurate claim documentation and meet established productivity, quality, and turnaround time goals.
• Participate in process improvement initiatives and support cross-functional projects to enhance claims operations.

Required Qualifications:

• High School Diploma or GED required.
• Minimum 3 years of experience in healthcare claims processing, insurance operations, or a related field.
• Experience processing medical insurance claims, payment adjustments, and claim corrections.
• Knowledge of Medicare, health insurance benefits, eligibility verification, and coordination of benefits.
• Strong analytical, problem-solving, and organizational skills.
• Excellent verbal and written communication skills.
• Ability to work independently while managing multiple priorities in a fast-paced environment.
• Proficiency with claims processing systems and Microsoft Office applications.

About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.