We are seeking a detail-oriented and customer-focused Claims Specialist to join a growing healthcare-related organization. This role is ideal for someone with experience working with medical insurance, healthcare claims, or medical billing who enjoys problem-solving, investigating claim issues, and helping patients receive the coverage they deserve.
This position offers comprehensive training from a highly experienced team member and provides an excellent opportunity for someone looking to build a long-term career through Contract-to-Hire in medical claims and insurance administration that is outside of a hospital or provider environment.
What You'll Do
As a Claims Specialist, you will play a key role in processing insurance claims and ensuring patients receive accurate billing and reimbursement information.
Responsibilities include:
- Verify insurance coverage, deductibles, and eligibility through payer websites and direct communication with insurance carriers
- Review patient insurance information, prescriptions, and supporting documentation
- Process insurance claims accurately within the claims management system
- Monitor claim status and investigate denied or rejected claims
- Work with insurance companies, physician offices, and patients to obtain missing information and required documentation
- Research authorization requirements, coding issues, and claim discrepancies
- Correct and resubmit claims when necessary
- Review Explanation of Benefits (EOBs) to determine patient balances, refunds, or additional amounts due
- Maintain accurate records and documentation throughout the claim lifecycle
What We're Looking For
Required Qualifications:
- Experience working with medical insurance, healthcare claims, medical billing, or a related healthcare administrative role
- Strong attention to detail and accuracy
- Ability to investigate issues and follow through to resolution
- Confidence communicating with insurance representatives, physician offices, and patients
Preferred Qualifications:
- Experience processing and appealing insurance claims
- Familiarity with EOBs, prior authorizations, and healthcare reimbursement processes
The Successful Candidate Is:
- Curious and resourceful when faced with claim challenges
- Comfortable picking up the phone and working directly with insurance carriers to find answers
- Organized and able to manage multiple claims at various stages of processing
- Patient, persistent, and solutions-oriented
- Eager to learn and develop expertise in medical claims administration
Why Consider This Opportunity?
- Extensive training and knowledge transfer provided
- Opportunity to develop specialized expertise in medical insurance claims
- Collaborative, team-focused environment
- Meaningful work that helps patients obtain insurance coverage for healthcare-related products and services
If you enjoy problem-solving, working with insurance carriers, and helping people navigate complex healthcare processes, we encourage you to apply.