Claims Specialist

A company is looking for a Claims Specialist to join their team, focusing on claims processing accuracy and quality assurance.

Key Responsibilities

Investigate claims that fail to process correctly and identify root causes

Create and manage tickets for configuration fixes and provide actionable recommendations

Analyze coding discrepancies and draft process documentation

Required Qualifications

Minimum 3 years of relevant experience in claims analysis or quality review

Commercial insurance experience is mandatory

Strong understanding of provider networks and payment processing

Experience in claims quality reviews and process documentation

Proven ability to troubleshoot claims errors and recommend solutions