Medical Claims Specialist

Overview

Medical Claims Specialist

Key Responsibilities

• Review, process, and follow up on medical insurance claims submitted to insurance companies and third-party administrators (TPAs).
• Ensure claims are accurately prepared and submitted in accordance with payer requirements and regulatory standards.
• Monitor claim status and proactively follow up on unpaid, pending, or rejected claims.
• Analyze claim denials and implement corrective actions to maximize reimbursement and reduce future rejections.
• Coordinate with clinical, billing, coding, and finance teams to resolve claim-related issues.
• Maintain strong relationships with insurance providers and TPAs.
• Prepare regular reports on claims performance, collections, rejection trends, and recovery opportunities.
• Support continuous improvement initiatives related to revenue cycle management and claims processes.

& Requirements

• Bachelor's degree in Healthcare Administration, Medical Sciences, Business Administration, or a related field.
• Minimum
• 7 years of proven experience
• in medical insurance claims management within hospitals, healthcare groups, insurance companies, or TPAs.
• Strong knowledge of healthcare insurance regulations, claim submission procedures, coding systems, and reimbursement methodologies.
• Experience in denial management, claims reconciliation, and revenue cycle optimization.
• Excellent analytical, communication, and problem-solving skills.
• Proficiency in healthcare information systems and Microsoft Office applications.
• Professional certifications related to healthcare insurance or revenue cycle management will be considered an advantage.
• We offer an excellent professional environment and opportunities for growth within a dynamic organization.
• Qualified candidates are encouraged to apply