Claims Operations Specialist

A company is looking for a Claims Operations Specialist to manage the billing process for medical and pharmacy claims.

Key Responsibilities

Oversee the full revenue cycle process for medical and pharmacy claims, including submission, QA, payment posting, and AR follow-up

Review, investigate, and resolve claim denials and rejections to ensure timely reimbursement

Assist with client onboarding, including claims setup and payer integration

Qualifications

Bachelor's degree in Healthcare Administration, Business, or a related field, or equivalent practical experience

CPB, CRCS, or CMRS certification strongly preferred

4+ years of experience in revenue cycle management, medical billing, or claims operations

Experience with Candid or similar RCM platforms preferred

Advanced Excel skills and familiarity with BigQuery, Looker, NetSuite, and Candid