Medical Claims Specialist

About the Role

The Claims Assistant will play a vital role in supporting AHC's claims processing operations under the direction of the Director of Claims Processing. This position is responsible for accurately submitting healthcare claims, verifying member eligibility, and proactively following up on unpaid and denied claims to ensure timely reimbursement. The ideal candidate is detail-oriented, organized, and comfortable working in a fast-paced healthcare environment.

Key Responsibilities

• Submit healthcare claims accurately and in a timely manner to insurance companies and government programs
• Verify member and participant eligibility and insurance coverage prior to claim submission
• Follow up on unpaid, pending, and denied claims and work denials to resolution
• Review and interpret Explanation of Benefits (EOBs) and remittance advice documents
• Identify and correct claim errors or discrepancies to minimize rejections and delays
• Maintain accurate and up-to-date claims records and documentation
• Communicate with insurance carriers, internal teams, and leadership regarding claim status and issues
• Assist the Director of Claims Processing with reporting, audits, and process improvement initiatives
• Ensure compliance with applicable billing regulations, payer guidelines, and company policies

Required Skills & Qualifications

• High school diploma or equivalent required; Associate's degree or coursework in healthcare administration preferred
• Minimum of 1–2 years of experience in medical billing, claims processing, or a related healthcare administrative role
• Working knowledge of medical terminology, ICD-10, and CPT coding
• Familiarity with insurance payer portals, clearinghouses, and electronic claims submission
• Proficiency in Microsoft Office Suite and medical billing or practice management software
• Strong attention to detail and commitment to accuracy
• Excellent written and verbal communication skills
• Ability to manage multiple priorities, meet deadlines, and work both independently and collaboratively

Pay: $40,000.00 - $45,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person