Claims Specialist

A company is looking for a Claims Specialist III responsible for capturing, resolving, and reporting on claim adjustment requests.

Key Responsibilities

Resolve complex COB issues and maintain accountability for daily tasks and goals

Process and adjust a variety of claims accurately and timely while identifying potential process improvements

Act as a technical resource for training and ensure all provider issues are resolved within appropriate timeframes

Required Qualifications

High School Diploma or equivalent is required

A minimum of one (1) year of experience in a claims environment or related healthcare operations is required

Previous experience in an HMO or related industry is preferred

Previous Medicare / Medicaid dual eligible claims experience is preferred

Experience in a Managed Care Organization or related healthcare industry is preferred