Insurance Claims Specialist

To improve and reduce the severity of complex claims, the full-time Texas Licensed Clinical Claims Specialist will provide cost-of-care estimates, consult on medical standards, and collaborate with stakeholders to implement claims savings solutions in a remote environment. Key responsibilities Provide explanations of disease states and associated costs to stakeholders Consult with underwriting on medical care approaches and standards Review claims and clinical documents to identify opportunities for cost reduction and quality improvement Required qualifications Licensure as a RN or Bachelor's in Healthcare Management or related field A minimum of 5 years of clinical/risk management experience Experience and/or knowledge of health insurance processes CCM, NANCM, or other relevant certification is a plus Strong organizational skills with proven time management experience