Claims/Benefits Specialist

Claims/Benefits Spec

Bellaire, TX - 77401 (Remote or Hybrid)

3 Months (Extension Possible)

Duties

• To investigate and accurately process claim appeals within the regulatory requirements mandated by the State of Texas.
• Process Specialists Adjustments, Replacements, Refunds, and Appeals Queues, at 98% average, within 30 days of receipt. (Specialists must process a minimum of 6 claims per hour, per day, annual average).
• Process group queues content at 98% average, within 30 days of receipt.
• Review and process pended claims, within 5 days of initial review.
• Respond to internal inquiries within 48 hours of receipt. Review, investigate and provide accurate and efficient follow-up.
• Ensure Special Projects are completed accurately, in a timely and efficient manner.
• Participates in system testing and reviews for upgrades/implementation.

Skills

• Knowledge of the most recent ICD, CPT/HCPCS coding methodologies (and their successors), as well as general principles with claims processing guidelines
• Strong organizational skills
• Critical thinking
• Detail oriented
• Mathematical aptitude
• Microsoft Office (Word, Excel, etc.)
• Self-motivated & works independently in initiating

Education

H.S. Diploma or GED

3 years claims processing experience A Bachelors degree may substitute for the required experience.