Claims Specialist I

Resolving medical claims that are not automatically adjudicated, the full-time remote Claims Specialist I will ensure timely and accurate claim processing by conducting investigations and communicating with necessary parties to gather information. Key responsibilities Process pended claims by entering data, reviewing contract benefits, and determining benefit eligibility Stay current with processing procedures and maintain knowledge of relevant computer systems and coding manuals Perform additional duties as assigned to support overall claims processing operations Required qualifications High School diploma or equivalent Minimum two years of college coursework or equivalent certification in a related field At least one year of related office experience in claims processing or health insurance Must pass company proficiency test: Claims Assessment Familiarity with ICD, CPT, and HCPS codebooks is preferred