Claims Specialist (Remote)

Job Description

Job Description

Claims Specialist (Dispute Resolution) *Please Note: Associates/Bachelor 's Degree Required*

Pay Rate: $20.00 - $25.00/hour
Location: Remote (U.S. Based)
Contract: 6-12 months + (I.e. Indefinite Contract)
Schedule: Monday-Friday, 8:00 AM - 5:30 PM
Equipment: Provided!

About the Opportunity

Medix is partnering with a nationally recognized healthcare quality and review organization to hire Claims Specialists supporting medical claims appeal and dispute resolution programs. As part of a growing initiative, this team plays a critical role in ensuring medical claims are reviewed efficiently, documentation is processed accurately, and cases move through the review process in accordance with established quality and compliance standards.

This is an excellent opportunity for professionals with healthcare administration or medical claims experience who enjoy investigative work, cross-functional collaboration, and managing complex case workflows in a remote environment.

Position Overview

The Claims Specialist supports the resolution of medical claims disputes and appeals through end-to-end case coordination, documentation management, and communication with internal and external stakeholders. This role serves as a liaison between healthcare plans, providers, patients, and clinical review teams to ensure cases are processed accurately and within established deadlines.

Success in this role requires strong organizational skills, attention to detail, effective communication, and the ability to manage multiple priorities in a fast-paced, deadline-driven environment.

Key Responsibilities

• Serve as the primary point of contact for medical claims appeal and dispute resolution programs
• Coordinate communication between healthcare plans, providers, patients, clients, and internal teams
• Monitor appeal/dispute status through client portals and internal tracking systems
• Conduct initial eligibility and case reviews, escalating recommendations to internal leadership as needed
• Track, assign, and manage cases using internal workflow systems
• Compile and distribute case documentation to clinical reviewers, including coders, nurses, physicians, and other stakeholders
• Ensure timely completion of deliverables while maintaining quality and compliance standards
• Monitor key performance indicators (KPIs), including turnaround time, accuracy, and contract requirements
• Identify workflow barriers and recommend process improvements
• Participate in daily/regular team huddles and provide case status updates in an agile workflow environment
• Schedule meetings, document decisions, and track next steps/action items
• Prepare and submit billing invoices upon case completion and coordinate with finance/accounting teams
• Train and mentor new team members on processes and case progression
• Other duties as assigned

Required Qualifications

• Associate's or Bachelor's degree in Healthcare, Business, Management, Digital Studies, or related field
• Minimum 2 years of experience in healthcare administration, medical claims, appeals, case management, or related field
• Strong written and verbal communication skills, including professional phone etiquette
• Ability to work independently with minimal supervision
• Strong problem-solving skills and ability to collaborate across clinical and administrative teams
• Ability to manage multiple priorities in a deadline-driven environment
• Flexible, adaptable, and comfortable working in a fast-paced workflow environment

Technical Skills

• Experience with internal case management or workflow systems (training provided)
• Proficiency with Microsoft Office Suite (Excel, Outlook, Word)
• Comfortable working with electronic documentation and tracking tools

Training & Onboarding

• 2-4 week structured training program provided
• Training includes systems navigation, workflow processes, and case handling procedures
• Ongoing support provided during ramp-up period

Preferred Qualifications

• Prior experience with medical claims, appeals, utilization review, or revenue cycle operations
• Exposure to payer/provider communication workflows
• Experience working in high-volume case processing environments

Additional Information

• Equipment provided for remote work
• Temporary equipment deposit policy applies: $50/week deducted for 10 weeks ($500 total), fully refunded after 10 weeks upon compliance with policy
• Onboarding includes background check, drug screening, and health screening
• Business casual dress code (professional virtual environment expected)
• Employment is through Medix for the duration of the assignment

For California Applicants:

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).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. 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.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?