Claims Specialist

Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ensuring timely reimbursement across commercial and workers' compensation payers.

The ideal candidate is detail-oriented, proactive, and experienced in behavioral health billing workflows, including claim corrections, payer communication, and AR resolution. At this time, this position is 100% on-site in Irvine, CA and is not eligible for remote work.

Responsibilities:
• Claims Processing: Review and process incoming claims for accuracy, completeness, and compliance with policies and regulations.
• Claims Evaluation: Evaluate and assess the validity of claims based on established guidelines, reviewing medical records, police reports, and other relevant documentation.
• Claims Payment: Coordinate with the finance department to ensure timely and accurate claims payments.
• Investigation and Resolution: Investigate complex claims, including fraud prevention and risk analysis, and resolve any discrepancies or issues in a timely manner.
• Documentation: Maintain detailed and accurate records of claims processed, including all correspondence and supporting documentation.
• Compliance: Ensure all claims are processed in accordance with company policies, industry standards, and legal requirements.
• Reporting: Provide regular reports on claims status, processing times, and claim trends to management.
• Any other duties as assigned by department

Minimum Requirements:
• Experience: Minimum of 2-3 years of experience in claims processing or a related field.
• Knowledge: Understanding of insurance policies, claims procedures, and industry regulations.

Competencies:
• Detail-Oriented: Ability to carefully evaluate and manage claims with a high degree of accuracy.
• Problem-Solving Skills: Strong analytical and problem-solving skills to address and resolve issues in claims.
• Technical Skills: Proficiency in MS Office (Word, Excel, Outlook) and claims management software (e.g., Guidewire, VUE, etc.).
• Customer Service: Ability to deliver excellent customer service and resolve issues in a timely manner.
• Time Management: Strong organizational and time-management skills, with the ability to handle multiple tasks efficiently.