Claim Benefit Specialist- Commercial Operations
Core
Reviews and adjudicates medical claims, verifies policy coverage, and ensures accurate reimbursement processing for healthcare providers and patients.
Role type
Claims processing specialist
Builds
Medical claims processing workflows
Domain
Healthcare administration
Required skills
claim documentation review, policy coverage verification, claim validity assessment, medical coding knowledge, billing practices, system data entry, regulatory compliance, claims data analysis
Preferred skills
healthcare experience, medical terminology understanding, multi-system utilization, production environment experience
Responsibilities
Process benefits claims submitted by healthcare providers, determine eligibility and coverage based on insurance plans, assess claims for accuracy and compliance, document claim information with appropriate codes, investigate claims requiring validation, communicate with stakeholders to resolve discrepancies, analyze claims data to identify trends and inform process improvements
Seniority
Entry-level, individual contributor
