Insurance Claims Specialist

📋 Description

• Review and process incoming claims in accordance with company policies, guidelines, and regulatory
• Enter claimant insurance data into claims processing systems accurately.
• Analyze claim, documents, and medical records to determine accuracy and eligibility.
• Identify discrepancies and follow up with providers, employers, or claimants as needed.
• Apply medical knowledge to interpret clinical notes, treatment plans, and diagnostic codes.
• Ensure timely adjudication while maintaining productivity and quality targets.

🎯 Requirements

• High school diploma or equivalent; associate degree or certification in medical billing a plus
• Minimum of 1+ years of claims processing experience in medical claims entry, billing or related
• Familiarity with medical terminology and reviewing medical records or clinical documentation
• Familiarity with U.S healthcare system, insurance terminology and claims processing
• Strong analytical and critical-thinking skills with high attention to detail
• Excellent written and verbal communication skills