Claims Specialist

A company is looking for a Claims Specialist to serve Medicare insurance customers by determining coverage and resolving medical claims.

Key Responsibilities

Process claims according to production, timeliness, and quality standards

Collaborate with other departments to resolve claims issues

Ensure compliance with governmental regulations and maintain quality customer service

Required Qualifications and Education

High school diploma or GED required

Minimum two years of experience in managed care claims processing

Understanding of hospital and physician contracts for determining payable benefits

Experience with claim processing systems and their internal configurations

An equivalent combination of education, training, and experience may be considered