Claims Specialist

Resolving medical claims that require manual adjudication, the full-time remote Claims Specialist I will ensure timely and accurate processing of claims while managing additional investigations and communications as needed. Key responsibilities Process and resolve pended claims by entering data, reviewing contract benefits, and determining benefit eligibility Stay current with processing procedures, benefits, and system modifications through ongoing training and education Perform additional duties as assigned, ensuring adherence to corporate and national standards for quality and productivity Required qualifications High School diploma or equivalent Minimum two years of college coursework (48 semester hours) in anatomy, medical terminology, math, biology, or a related field, or one year of related office experience Must pass company proficiency test: Claims Assessment Demonstrated ability to access and utilize relevant computer systems for claims processing Familiarity with corporate processing manuals and coding systems such as ICD, CPT, and HCPS