Healthcare Claims Specialist

Job Summary

We are seeking a proactive, detail-oriented Healthcare Claims Specialist to join our team. In this role, you will be responsible for managing and resolving healthcare insurance claims, ensuring accuracy, follow-through, and proper reimbursement. You will work directly with insurance companies, review claims and Explanation of Benefits (EOBs), and help drive claims through the full lifecycle from submission to resolution. This is not a basic billing role. Our team works on complex claims across the country, including ERISA and non-ERISA plans, where persistence and problem-solving are required to secure payment.

Duties

• Review, submit, and monitor medical insurance claims
• Track claim status and follow up with insurers to ensure timely processing
• Resolve unpaid or denied claims through direct payer communication
• Request claim corrections or reprocessing when necessary
• Verify insurance coverage and analyze policy details
• Review benefits, eligibility, and claim requirements
• Identify issues impacting reimbursement early in the process
• Review Explanation of Benefits (EOBs) for accuracy
• Identify underpayments, denials, or missing payments
• Ensure reimbursement aligns with expected benefits and coverage
• Maintain accurate and organized claim files and documentation
• Analyze medical records and supporting documentation
• Track claim timelines and maintain follow-up schedules
• Identify discrepancies and resolve claim issues efficiently
• Collaborate with internal team members to resolve complex claims
• Assist in reviewing cases to ensure all claims were properly billed
• Identify missing claims, EOBs, or revenue opportunities
• Support ongoing claim tracking and reporting processes

Requirements

• 2+ years experience in medical billing, insurance claims, or revenue cycle management
• Experience communicating directly with insurance carriers
• Strong understanding of Explanation of Benefits (EOBs) and claim lifecycle
• Strong customer service and communication skills
• Ability to manage multiple claims and deadlines
• Strong attention to detail and organizational skills

Preferred Qualifications

• College education preferred
• Strong experience in behavioral healthcare claims
• Experience with appeals, complaints, and evidence gathering a plus
• Experience in denials management or insurance follow-up
• Familiarity with Medicare, Medicaid, or commercial insurance plans
• Working knowledge of medical terminology and coding systems (ICD-10, CPT, HCPCS)

About FixMyClaim

FixMyClaim is a long standing patient advocate. FixMyClaim helps patients and healthcare providers recover insurance payments that were improperly denied or delayed. Our team works on complex claims across the country and regularly engages directly with insurance carriers to resolve issues and secure appropriate reimbursement on behalf of the patient. We work with both ERISA and non-ERISA health plans and support cases that often require detailed review and ongoing follow-up.

Work Location

• On-site, hybrid, or fully remote dependent on experience

Pay: $21.00 - $28.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance
• Work from home

Education:

• High school or equivalent (Required)

Experience:

• healthcare claims and billing: 2 years (Required)
• behavioral health claim/billing: 2 years (Preferred)

Work Location: Hybrid remote in Salt Lake City, UT 84107