Health Claims Specialists
Core
Process medical insurance claims via data entry and adjudication to determine payment amounts, ensuring accuracy and compliance with policy and HIPAA guidelines.
Role type
Claims Examiner (Data Entry)
Builds
Adjudicated medical claims for insurance clients
Domain
Healthcare / Insurance
Required skills
Data entry, Medical billing and coding, Medical terminology, Analytical abilities, Attention to detail, Time management, Computer knowledge
Preferred skills
Previous experience in medical office settings, Knowledge of Medicare/Medicaid/Child Plus insurance types
Technologies
Specific proprietary software (not named)
Responsibilities
Process claims via data entry, Adjudicate claims to meet production and quality metrics, Follow up on claims needing additional information, Refer problem claims to leads or auditors, Maintain data integrity and privacy per HIPAA guidelines
Seniority
Entry-level to Mid-level, individual contributor