Medical Claims Support I
Core
Investigates and processes medical claim adjustments, overpayment recovery, and COB updates for Medicare/Medicaid and commercial plans.
Role type
Medical Claims Support Specialist
Builds
Accurate claim adjustments and payment resolutions for insurance members and providers
Domain
Health Insurance / Medical Claims
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical claim processing, COB (Coordination of Benefits) updates, plan concept application (deductibles, coinsurance, copays), claims adjudication, refund processing, stop payment handling, medical terminology interpretation, 10-key proficiency (135 wpm), keyboard typing (35 wpm), claims processing systems (Facets, Word, Excel)
Preferred skills
Customer service inquiries, process improvement suggestions, internal department collaboration, programming issue assistance
Technologies
Facets, Microsoft Word, Microsoft Excel
Responsibilities
Investigate and process claim adjustments for all medical lines of business; Perform COB updates and file reviews; Issue adjustment-related letters to members and providers; Process payment offsets and validate stop payment requests; Resolve moderately complex claims issues; Communicate via telephone with claimants, policyholders, providers, and insurance carriers; Maintain unit inventory through adjustments and reports.
Seniority
Entry-level to Junior, individual contributor