Claims Specialist
Quadrant Health GroupBoca Raton, FL, United States10 days ago
Job type
- Full-time
Job descriptionProactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500700 claims per week , prioritizing efficiency and accuracy. Handle 45 hours of phone time per day with strong communication skills. Communicate with payers via phone, portals, and written correspondence to resolve billing issues. Identify trends in denials and underpayments and escalate systemic issues. Dispute and overturn wrongly denied claims . Update and track claims using CMD (CollaborateMD) and internal task systems. Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR . Maintain professional and timely communication with internal teams and facility partners. Handling refund requests and appeals . Preparing and submitting level 13 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Working with utilization review (UR) or clinical teams. Familiarity with ASAM and MCG medical necessity criteria . Exposure to payment posting, authorization reviews , or credentialing . Minimum 1 year of SUD / MH billing and claims follow-up experience (required). High School Diploma or equivalent, associate or bachelors degree (preferred). Strong understanding of insurance verification, EOBs, and RCM workflows . Familiarity with major payers : BCBS, Cigna, Aetna, UHC, Optum, TriWest . Experience overturning insurance denials is a strong plus . Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred). Excellent written and verbal communication skills. Highly organized, detail-oriented, and capable of managing multiple priorities. Rapid career growth in a mission-driven, niche billing company. Collaborate with clinical and billing experts who understand behavioral health. Join a tight-knit, supportive team culture. Gain opportunities for leadership advancement as the company scales.
Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, i s seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively.
Why Join Quadrant Health Group?
- Competitive salary commensurate with experience.
- Comprehensive benefits package, including medical, dental, and vision insurance.
- Paid time off, sick time and holidays.
- Opportunities for professional development and growth.
- A supportive and collaborative work environment.
- A chance to make a meaningful impact on the lives of our clients.
Compensation : $18 - $24 per hour - Full-time
What You'll Do :
The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. Youll join a high-performing team focused on maximizing collections, reducing aging A / R, and ensuring every dollar is pursued.
Major Tasks, Duties and Responsibilities :
Bonus Experience (Not Required) :
What You'll Bring :
Why Join Quadrant Billing Solutions?
#HP
Compensation details : 18-24 Hourly Wage
PI182ccc177339-29952-38267920
Create a job alert for this search
Claim Specialist • Boca Raton, FL, United States
Related jobs
A company is looking for a Claims Escalation Specialist responsible for reviewing and processing healthcare claims and escalations.
Key Responsibilities Review and analyze healthcare claims to ens...Show moreLast updated: 1 day ago A company is looking for a Claims Specialist to resolve complex claims and advocate for members navigating their healthcare benefits.
Key Responsibilities Resolve complex claims issues by investig...Show moreLast updated: 30+ days ago A company is looking for a Medicare Specialist to manage and resolve Medicare claims for multiple hospital or physician groups.
Key Responsibilities Resolve aged, outstanding, and denied medical c...Show moreLast updated: 29 days ago 
On-Site in Dania, FL This Role : As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the healthcare industry.You’ll contribut...Show moreLast updated: 30+ days ago A company is looking for a Claims Operations Specialist specializing in processing cyber insurance claims.Key Responsibilities Develop and implement processes for the intake, organization, and re...Show moreLast updated: 20 hours ago 
Where Your Success is Our Priority!.Are you a licensed and driven health insurance agent looking for consistent leads, real support and top-tier earning potential? At Legacy Health, we're commi...Show moreLast updated: 30+ days ago A company is looking for a Claims Analyst (Healthcare) to support their team in a remote capacity.Key Responsibilities Research, resolve, and follow up on rejected or unpaid pharmacy claims for a...Show moreLast updated: 8 days ago Key Responsibilities Review and develop action plans for appealed claims according to policy provisions Resolve appeals in a timely manner and communicate outcomes to relevant parties Collabora...Show moreLast updated: 1 day ago 
Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm.
It is at the core of how we operate and the reason for our suc...Show moreLast updated: 3 days ago A company is looking for a Claims Adjuster Workers Compensation.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims effectively Interact with various parti...Show moreLast updated: 30+ days ago A company is looking for a Claims Adjuster, Tire Operations, L1.Key Responsibilities Process claims accurately and in a timely manner while adhering to established guidelines Handle inquiries fr...Show moreLast updated: 30+ days ago 
We’re looking for a motivated listing agent to join our rapidly growing team! Our ideal applicant is a persuasive salesperson and enjoys a fast-paced work environment.
This is an exciting opportunit...Show moreLast updated: 23 days ago A company is looking for a Claims Examiner - Liability (REMOTE TX or WI).Key Responsibilities Evaluate commercial auto bodily injury claims and ensure proper documentation and coding Manage the ...Show moreLast updated: 30+ days ago 
Quadrant Health Group! Quadrant Billing Solutions, .Claims Specialist to join our growing team.You will play a vital role focused on ensuring that healthcare services are delivered efficiently...Show moreLast updated: 9 days ago A company is looking for an LTSS Specialist I to support care coordination and improve member healthcare experiences.Key Responsibilities Ensure compliance with contractual obligations and govern...Show moreLast updated: 1 day ago 
Technical Claims Specialist - Worker's Compensation.US-IL-Chicago | US-FL-Maitland | US-FL-Boca Raton | US-TX-Dallas | US-GA-Alpharetta.
AmTrust Financial Services, a fast-growing commercial insuran...Show moreLast updated: 30+ days ago A company is looking for a Principal Claims & Payments Expert to serve as a lead authority on claims-related policy matters.
Key Responsibilities Interface directly with providers on claims polici...Show moreLast updated: 1 day ago A company is looking for a Senior Claims Adjuster - Premises, Slip and Fall / Restaurant and Retail.Key Responsibilities Investigate, evaluate, and resolve complex commercial general liability clai...Show moreLast updated: 30+ days ago A company is looking for an Insurance Claims Specialist PB.Key Responsibilities Submit accurate and timely claims to third party payers Resolve claim edits and account errors prior to claim subm...Show moreLast updated: 30+ days ago A company is looking for a Team Lead, Claims.Key Responsibilities Manage a team of 12-15 claims examiners and adjusters Ensure adherence to client guidelines and monitor staff productivity and a...Show moreLast updated: 30+ days ago
- Promoted
Claims Escalation Specialist
VirtualVocationsFort Lauderdale, Florida, United StatesFull-time
- Promoted
Claims Specialist
VirtualVocationsPompano Beach, Florida, United StatesFull-time
- Promoted
Medicare Claims Specialist
VirtualVocationsTamarac, Florida, United StatesFull-time
Claims Specialist, Audit & Contracting
LogixHealthDania, FL, USFull-time
Quick Apply
- Promoted
- New!
Cyber Claims Operations Specialist
VirtualVocationsFort Lauderdale, Florida, United StatesFull-time
- Promoted
Health Insurance Sales Specialist
Legacy Health, LLCTamarac, FL, USFull-time
- Promoted
Healthcare Claims Analyst
VirtualVocationsBoca Raton, Florida, United StatesFull-time
- Promoted
Senior Appeals Specialist
VirtualVocationsTamarac, Florida, United StatesFull-time
- Promoted
Claim Specialist - Property Field Inspection
State FarmWest Palm Beach, FL, United StatesFull-time
- Promoted
California Licensed Claims Adjuster
VirtualVocationsTamarac, Florida, United StatesFull-time
- Promoted
Claims Adjuster
VirtualVocationsDavie, Florida, United StatesFull-time
- Promoted
Real Estate Listing Specialist
Tricoli Team Keller Williams RealtyWellington, Florida, United States, 33414Full-time
Quick Apply
- Promoted
Texas Licensed Claims Examiner
VirtualVocationsFort Lauderdale, Florida, United StatesFull-time
- Promoted
Claims Specialist
Quadrant Health GroupBoca Raton, FL, USFull-time
- Promoted
LTSS Specialist
VirtualVocationsHialeah, Florida, United StatesFull-time
- Promoted
Technical Claims Specialist - Worker's Compensation
AmTrust FinancialBoca Raton, FL, United StatesFull-time
- Promoted
Principal Claims Policy Expert
VirtualVocationsHollywood, Florida, United StatesFull-time
- Promoted
State Licensed Senior Claims Adjuster
VirtualVocationsHollywood, Florida, United StatesFull-time
- Promoted
Insurance Claims Specialist
VirtualVocationsWest Palm Beach, Florida, United StatesFull-time
- Promoted
Claims Team Lead
VirtualVocationsHialeah, Florida, United StatesFull-time