Medical Claims Processor / Medical Claims Specialist

Job Title : Medical Claims Processor / Medical Claims Specialist

Pay Rate : $23.00 / hour

Schedule : 11 : 30 AM - 8 : 00 PM

Language Requirement : Bilingual-Spanish & English (Required)

Location : Glastonbury CT 06033 (Not a remote position)

Position Summary :

We are currently seeking a detail-oriented, organized, and compassionate Medical Claims Processor / Medical Claims Specialist to join our growing team. This role requires fluency in both English and Spanish and the ability to thrive in a fast-paced environment. The ideal candidate will have strong analytical skills, a customer-focused mindset, and the ability to manage multiple priorities while maintaining accuracy and professionalism.

Key Responsibilities :

Process and adjust medical insurance claims in accordance with company policies and procedures

Respond to incoming calls from clients and medical providers regarding payment statuses and claims

Make outgoing calls to providers and insurance companies to follow up on outstanding items

Interpret Explanation of Benefits (EOBs) and medical terminology

Identify, research, and resolve claim issues, including documentation requests

Promote teamwork and ensure service delivery standards are met

Process medical payments and support client appeals processes

Maintain accurate financial records and assist with batch processing

Audit outgoing payments for accuracy and compliance

Manage team workflow and call logs

Assist high-utilization clients and suggest process improvements

Perform additional administrative duties as assigned

Qualifications :

Language : Must be bilingual in Spanish and English

Education : Associate's degree (A.A. / A.S.) preferred, or equivalent work experience

Experience : 2-4 years in medical claims processing, billing, or insurance customer service

Computer Skills : Proficiency with Microsoft Office, internet-based tools, and proprietary software

Preferred : Experience with medical coding, billing, or claims processing

Skills & Competencies :

Strong communication and interpersonal skills

Excellent attention to detail and ability to multitask

Solid mathematical and reasoning abilities

Ability to handle confidential information with integrity

Comfortable working with diverse populations and high-volume workloads

Certifications :

Medical billing / coding or insurance claims processing certification required

If you're passionate about healthcare administration and providing excellent support to patients and providers, we encourage you to apply today!

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