Medical Claims Intake Specialist

Position Summary

The Medical Claims Intake Specialist is responsible for the accurate and timely intake, validation, and indexing of medical claims and related documentation. This position supports claims processing operations by ensuring incoming claims meet submission requirements and are routed appropriately. The ideal candidate will have 1–2 years of experience in medical claims or healthcare administration and be able to independently manage workload while meeting established quality, productivity, and volume standards.

Essential Duties and Responsibilities

Receive, review, medical claims, correspondence, and supporting documentation.

Validate claim submissions for completeness, legibility, and required data elements in accordance with business rules.

Identify discrepancies, missing information, or non-compliant submissions and route or escalate as appropriate.

Independently prioritize and route claims to the correct processing queues based on claim type and urgency.

Maintain accuracy and consistency while processing high daily claim volumes.

Ensure strict adherence to HIPAA guidelines and protection of protected health information (PHI).

Communicate clearly and professionally with internal teams to resolve intake or documentation issues.

Participate in quality assurance activities and incorporate feedback to improve performance.

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Performance Metrics – Claims Volume and Productivity

Process an average set of claims per day, based on claim complexity and intake method.

Meet established service-level agreements (SLAs) for claim indexing and routing turnaround time.

Maintain a minimum accuracy rate of 95% or higher while meeting volume expectations.

Effectively manage assigned intake queues to prevent backlog.

Demonstrate consistent productivity throughout the workday while maintaining quality and compliance.

Qualifications

High school diploma or GED required.

Minimum of 1–2 years of experience in medical claims intake, claims processing, healthcare administration, or a related role required.

Familiarity with medical terminology and claim forms (CMS-1500, UB-04, Dental) preferred.

Understanding of full revenue cycle management (RCM) and claims adjudication.

Compliance and Confidentiality

Ensures the medical claims function operates in compliance with all federal, state, and company policies, including HIPAA privacy and security standards. Maintains strict confidentiality and promotes ethical conduct across the team.