Claims Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.


Job Summary


Our client is seeking a dedicated Claims Specialist to join a collaborative team focusing on air ambulance claims, member appeals, and insurance reimbursement. This detail-oriented role involves managing out-of-network claims, advocating for members, and building relationships with employers, patients, and insurance providers.


Key Responsibilities

• Manage 25-30 insurance claims per day with emphasis on accuracy, compliance, and timeliness.
• Navigate out-of-network claims and reimbursement workflows.
• Conduct eligibility and benefits verifications, especially for air ambulance-specific criteria.
• Investigate and process member appeals.
• Gather and submit prior authorizations, medical records, and necessary documentation.
• Collaborate with patients, families, employers, and insurance providers via phone, email, and online chat.
• Maintain detailed records in accordance with HIPAA and internal standards.
• Track personal productivity and quality metrics to qualify for monthly incentive bonuses.

Qualifications

• Minimum 2+ years of A/R and collections experience with good tenure.
• Must have out-of-network experience.
• Hospital or single-specialty background with commercial insurance is a plus.
• Strong critical thinking, problem-solving skills, adaptability, and excellent communication.
• Comfort with asking for help and collaborating with a team.

Skills

• Experience with out-of-network claims.
• Effective critical thinking and problem-solving skills.
• Strong communication skills and adaptability.

Additional Requirements

• Hybrid work model, with commute to office required 1-2x per month. The office is in North Scottsdale, Az
• Equipment provided must be picked up in person on the first day.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:


With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.


Any required state or Joint Commission training is compensated at the state or local minimum wage rate.


* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.