We currently have an opening for a Claims Specialist to work within a healthcare organization. The Claims Specialist will be responsible for processing and reviewing complex and routine medical, dental, hospital and/or disability claims. The ideal Claims Specialist has 2+ years of claims processing experience, great attention to detail, and is highly organized.
General Duties: - Process complex and routine medical, dental, hospital and/or disability claim. - Provide customer service by responding to and documenting telephone and/or written inquiries. - Perform pre-authorizations, audit files, request check tracers and stop payments, and assist with researching and preparing appeals. - Maintain current knowledge of assigned Plan(s) and effectively apply knowledge in all job functions. - Consistently meet established performance standards, including quantity and quality call standards. - Consistently demonstrate excellent attendance and punctuality. - Occasional work outside of normal work hours (i.e. weekends/extended hours) based on business needs. - Perform special projects as requested by management. - Perform other duties as assigned within the scope of responsibilities and requirements of the job.