Medical Insurance Claims Specialist

Job Description

Job Description

We are looking for a dedicated Medical Insurance Claims Specialist to join our team on a contract basis in San Diego, California. In this role, you will manage insurance claims, verify patient eligibility, and ensure accurate processing of medical billing. This position requires strong communication skills, attention to detail, and a commitment to delivering excellent service to patients and healthcare professionals.

Responsibilities :

• Verify patients’ insurance coverage, including eligibility, copayments, deductibles, and pre-authorization requirements.
• Submit and manage treatment authorizations, ensuring timely approvals and addressing denials or escalations.
• Communicate with patients to explain their insurance benefits, financial responsibilities, and address any concerns.
• Collaborate with billing staff to ensure accurate processing of claims based on verified insurance information.
• Maintain detailed documentation of insurance verification activities, including interactions with insurance providers and patients.
• Resolve discrepancies in coverage and authorization denials, escalating complex cases when necessary.
• Coordinate with healthcare providers and administrative teams to improve the patient experience.
• Ensure compliance with patient confidentiality regulations and organizational policies.
• Educate patients on out-of-pocket expenses and assist with inquiries about billing procedures.
• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Minimum of 1 year experience in insurance verification, medical billing, or healthcare administration.
• Proficiency with insurance verification software, electronic health records, and Microsoft Office applications.
• Strong communication skills, both verbal and written, with the ability to interact effectively with patients and insurance representatives.
• Excellent attention to detail and accuracy in documentation.
• Ability to work independently and collaboratively in a fast-paced environment.
• Familiarity with medical terminology and insurance billing codes is a plus.
• Knowledge of patient privacy laws and compliance regulations.