health insurance specialist

Beacon Health System

<div><div><div><div><div><div>Beacon Health System is hiring a full-time day Patient Access Insurance Specialist, in our Verification of Benefits Department at Beacon Health System in South Bend, IN. 
 
Be a Beacon. Make a Difference.
At Beacon Health System, you&rsquo;re not just part of a team, you&rsquo;re part of something bigger. Every patient interaction is a chance to lead with compassion, build trust, and create lasting impact. Here, your expertise supports healing, and your heart connects us to the communities we serve.
<ul><li>Medical, Dental, &amp; Vision Insurance through Cigna</li>
</ul><ul><li>Life Insurance</li>
</ul><ul><li>403(b) Matching Retirement Fund</li>
</ul><ul><li>Competitive Paid Time Off (PTO)</li>
</ul><ul><li>Shift Differentials</li>
</ul><ul><li>Employee Assistance Program (EAP)</li>
</ul><ul><li>Tuition and Certification Reimbursement</li>
</ul><ul><li>Clinical Ladder Program</li>
</ul><ul><li>Local and National Discounts</li>
</ul><ul><li>Beacon Academy Educational Courses</li>
</ul><ul><li>Gym Membership Discount</li>
</ul>
About Beacon Health System
Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.
What You&rsquo;ll Do
As a Patient Access Insurance Specialist, you will report to the Patient Access Director or the Insurance Specialist Supervisor. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider. The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures. They will work closely with medical staff, clinical staff, referring clinics, Beacon Outpatient Scheduling Surgery Scheduling, Social Services, and Utilization Review departments. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring authorization, pre-certification, and prior approval for admissions to Beacon or Epworth Center by using web-based tools, other electronic means where possible, or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Utilization Review, Social Services, Beacon Outpatient Scheduling and Surgery Scheduling departments. Performs other clerical duties as necessary.
Patient Access Insurance Specialist Job Responsibilities:
<ul><li>Verify and update patient demographic and financial information to ensure accuracy in the registration system.</li>
<li>Obtain and validate insurance coverage using online eligibility systems, payer portals, and telephone verification.</li>
<li>Utilize Cerner systems and reports (e.g., PHS, SurgiNet, Medical Necessity Checker) to review scheduled patients, procedures, and medical necessity requirements.</li>
<li>Audit and complete required documentation, including MSP questionnaires and insurance verification records.</li>
<li>Coordinate verification of benefits (VOB) by confirming co-pays, deductibles, coinsurance, out-of-pocket limits, and rehabilitation benefits with insurance providers.</li>
<li>Secure and document pre-authorizations and pre-certifications for ancillary, surgical, outpatient, and inpatient procedures.</li>
<li>Collaborate with physician offices, scheduling teams, and referring facilities to ensure required authorizations are obtained and procedures are properly scheduled.</li>
<li>Validate CPT and ICD-10 codes and confirm compliance with Medicare Inpatient Only Procedure (MIPO) requirements when applicable.</li>
<li>Identify out-of-network insurance plans and follow established policies and procedures.</li>
<li>Refer patients to Financial Counselors or Eligibility Specialists when financial clearance or payment arrangements are required.</li>
<li>Maintain accurate worklists, documentation, and records to support timely claim submission and reimbursement.</li>
<li>Calculate and communicate estimated patient financial responsibility, including co-payments and coinsurance.</li>
<li>Prepare reports, patient statistics, and documentation to support departmental operations and leadership requests.</li>
<li>Provide professional customer service by answering calls, communicating with patients and internal departments, and maintaining positive patient relations.</li>
<li>Collaborate with departments such as Utilization Review, Surgery Scheduling, Social Services, and Outpatient Scheduling to ensure accurate and timely patient processing.</li>
<li>Support departmental quality goals by maintaining productivity, accuracy, and compliance with Beacon policies and procedures.</li>
<li>Maintain professionalism while representing Beacon Health System and perform other duties as assigned.</li>
</ul>
What You Bring
As a Patient Access Insurance Specialist, it requires strong office and computer skills, including keyboarding (minimum 40 wpm), data entry, and proficiency with systems such as Cerner, Pathways Healthcare Scheduling, Experian, and MCA Compliance Checker. Demonstrates knowledge of medical terminology, insurance coverage, managed care networks, ICD-10 and CPT codes, and time-of-service collections, including the ability to clearly communicate financial responsibilities to patients. You will possess strong telephone, verbal communication, and listening skills to effectively interact with patients, insurance companies, physicians, and internal departments. You will maintains professionalism and sensitivity when working with diverse populations, follows strict confidentiality policies, exercises sound judgment in stressful situations, and applies basic math skills to calculate patient financial responsibilities such as deductibles, coinsurance, and out-of-pocket costs.
Required Qualifications
<ul><li>The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent).
</li><li>A minimum of two years of experience in a hospital or physician practice business office is required.
</li><li>Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required.</li>
<li>A medical terminology course must be successfully completed prior to employment.
</li><li>Associate's degree preferred.
</li><li>Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.</li>
</ul>
The Beacon Way
At Beacon Health System, our approach to care goes beyond clinical excellence because it&rsquo;s built on meaningful connections. Guided by our core values of Trust, Respect, Integrity, and Compassion, we strive to create an environment where patients feel heard, employees feel valued, and innovation thrives.
We call this commitment The Beacon Way&mdash;a six-point operating system that empowers every team member to lead with purpose, communicate clearly, cultivate talent, embrace performance improvement, leverage innovation, and build greatness through accountability. Whether at the bedside or behind the scenes, everyone at Beacon plays a role in moving health forward.</div> 
</div>
</div></div></div> 
Location: Beacon Health System &middot; Verification of Benefits 
Schedule: Full-time, Day, 0830-5pm M-F</div>

Patient Access Insurance Specialist, Verification of Benefits Department, Full-Time Days

SKYGEN

<div>Important things YOU should know:
<ul><li>Schedule: Monday - Friday 8:00am - 4:30pm CST
</li><li>Friday schedule includes covering a 7:00pm - 8:00pm shift on a rotational basis
</li><li>Fully Remote Opportunity
</li><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Potential to Flex Schedule 
</li></ul>What will YOU be doing for us? Responsible for ensuring departmental tasks are completed in order to meet client turnaround times for claim payment and authorization determination. Manages all special handling requests to support both internal and external requirements 
What will YOU be working on?
<ul><li>Manages daily work plan and distributes work out to the team to ensure client turnaround times are met.
</li><li>Provide second tier support to data entry processors by providing direction how to resolve submission discrepancies according to client business rules.
</li><li>Manage specialized workflows to support client requests that deviate from standard processes and procedures. Coordinate resolution with required departments as necessary.
</li><li>Responsible for ensuring all reporting is reviewed, work queues are completed, and open issues are resolved prior to claim payment and authorization review. Proactively communicate readiness to transfer data to appropriate departments.
</li><li>Proactively communicate potential issues to management to allow for timely resolution.
</li><li>Ability to multitask within multiple modules of the Enterprise System to retrieve and research information along with processing any submission requests or special handling requests received.
</li><li>Comprehensive understanding of client processing guidelines and requirements.
</li><li>Process primary insurance carries EOB&rsquo;s for appropriate payment.
</li><li>Act as a subject matter expert for items sent to the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
</li><li>Proactively bring forward provider submission errors and collaborate with internal teams for provider outreach and education.
</li><li>Manage and process urgent operating room (OR) authorization requests submitted via fax and coordinate with the authorization team to ensure timely review and determination outcome.
</li><li>Resolve provider data discrepancies submitted electronically that prevent the submission to proceed through the system. Utilize outside databases to validate provider credentials.
</li>Assists with training support of internal team members. 
<li>
</li></ul>Additional Responsibilities:
<ul><li>Partner with Claims Intake team in completing all other tasks as necessary to ensure accurate and timely completion of work to meet our client service level agreements.
</li>Assist with special projects requests assigned by leadership team. 
<li>
</li></ul>What qualifications do YOU need to have to be a GOOD candidate?
Required Level of Education, Licenses, and/or Certificates
High school diploma or equivalent. 
<ul><li>
</li></ul>Required Level of Experience
1+ year(s) of related experience such as claim processing, dental assistant, dental front office administration and/or health/dental insurance such as managed care operations, accounts receivable and/or billing environment. 
<ul><li>
</li></ul>Required Knowledge, Skills, and Abilities
<ul><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Ability to work effectively with multiple interruptions.
</li><li>Ability to organize work appropriately to meet deadlines.
</li><li>Excellent attention to detail.
</li><li>Ability to multi-task.
</li><li>Ability to utilize resources to solve problems independently.
</li><li>Excellent Critical thinking skills.
</li><li>Excellent verbal and written communication skills.
</li><li>Basic Microsoft applications.
</li><li>Knowledge of insurance EOB&rsquo;s and billing codes.
</li>Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim form or Member Reimbursement forms. 
<li>
</li></ul>What qualifications do YOU need to have to be a GREAT candidate?
Preferred Level of Education, License, and/or Certificates
Bachelor&rsquo;s Degree in a related field. 
<ul><li>
</li></ul>Preferred Level of Experience
<ul><li>2+ years of medical, dental or vision claim processing.</li></ul></div>

Claims Intake Specialist II

Old Republic International

<div>WHO ARE WE? 
Old Republic Surety Company underwrites contract, fidelity, and commercial bonds, serviced through a strong and partnered network of independent insurance agencies. Solutions provided include bid bonds, performance and payment bonds, and maintenance bonds for large, middle market and smaller growing contractors. ORSC consistently offers superior service and creative underwriting options in all 50 states and some of the U.S. territories.
ORSC continues to expand it geographic footprint and product offering while consistently delivering significant, market-leading growth and maintaining a strong underwriting margin.<div>
Are you ready to take your career to the next level as a Claims Specialist with a company known for stability, expertise, and integrity? At Old Republic Surety Company, we&rsquo;re looking for a driven and detail-oriented Claims Specialist who thrives in a fast-paced environment and is passionate about delivering fair, timely, and strategic claim resolutions.</div><div></div><div> 
</div><div>
As a Claims Specialist, you&rsquo;ll play a role in protecting our clients and our business by managing complex commercial surety claims from investigation through resolution.</div><div></div><div> 
</div><div>
We&rsquo;re seeking a Claims Specialist who is analytical, proactive, and confident in decision-making. If you enjoy interpreting complex legal documents, negotiating outcomes, and collaborating with professionals across industries, this role is designed for you.</div><div>
</div><h3 class="jobSectionHeader">
What You&rsquo;ll Do as a Claims Specialist</h3><ul><li>
Ensure equitable claim service is performed in a timely and professional manner involving commercial surety claims</li><li>
Interpret bond language to determine company liability and identify issues requiring escalation</li><li>
Coordinate investigations, working closely with internal teams and external partners</li><li>
Evaluate resolution strategies and recommend effective courses of action</li><li>
Establish and maintain appropriate reserves while proactively mitigating loss</li><li>
Negotiate and settle claims within authority limits, clearly communicating liability decisions</li><li>
Develop surety defenses and manage complex coverage issues</li><li>
Pursue salvage opportunities, including indemnification and subrogation efforts</li><li>
Control Loss Adjustment Expenses through strategic use of attorneys, consultants, and accountants</li></ul><h3 class="jobSectionHeader">
What You Bring</h3><div>
As a successful Claims Specialist, you combine technical expertise with strong communication and organizational skills. You&rsquo;re comfortable working independently while managing multiple priorities with precision.</div><ul><li>
High School Diploma or equivalent required</li><li>
Minimum 2 years of related experience or 3 years in insurance claims</li><li>
Strong ability to interpret complex legal and financial documents</li><li>
Excellent negotiation and communication skills</li><li>
Proficiency with Microsoft Office and computer systems</li><li>
Exceptional attention to detail and organizational abilities</li><li>
Ability to maintain confidentiality and exercise sound judgment</li><li>
Strong proofreading and recordkeeping skills</li></ul>
COMPANY BENEFITS
Financial:<ul><li>
Competitive salary</li><li>
401k Savings &amp; Profit-Sharing Plan, including company match contribution</li><li>
Roth investment options</li><li>
529 Education Savings Plan</li><li>
Employee Referral Bonus Program</li></ul>
Health:<ul><li>
Health Insurance</li><li>
Dental Insurance</li><li>
Flexible Spending &amp; Health Savings Account options</li><li>
Life Insurance</li><li>
Vision Insurance</li><li>
Supplement Life Insurance</li><li>
Long-Term Disability Insurance</li><li>
Paid Leave of Absence Benefits</li><li>
Accident &amp; Critical Illness Insurance</li><li>
Pet Insurance</li></ul>
Work-Life Balance:<ul><li>
37.5 hour standard work week</li><li>
Casual business attire</li><li>
Generous paid time-off (PTO)</li><li>
Paid holidays</li><li>
Volunteer opportunities</li><li>
Company-sponsored events and outings</li></ul><div><div><div><div>
#LI-VG1</div></div></div></div>
Old Republic Surety Company is an Equal Opportunity Employer and is committed to maintaining a diverse workplace.</div>

Claims Specialist, Commercial

Mercor

<div>
 
 About The Job
 
 
 
 
 Mercor
 
 connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include
 
 Benchmark
 
 ,
 
 General Catalyst
 
 ,
 
 Peter Thiel
 
 ,
 
 Adam D'Angelo
 
 ,
 
 Larry Summers
 
 , and
 
 Jack Dorsey
 
 .
 
 
 
 Position:
 
 Registered Nurses
 
 
 
 Type:
 
 
 Contract
 
 
 
 
 Compensation:
 
 
 $60&ndash;$110/hour
 
 
 
 
 Location:
 
 
 Remote
 
 
 
 
 Duration:
 
 
 3&ndash;4 weeks
 
 
 
 
 Commitment:
 
 
 30&ndash;40 hours/week
 
 
 
 
 Role Responsibilities
 
 
 
 <ul>
 <li>
 Create deliverables addressing common requests in the nursing domain.
 </li>
 <li>
 Review peer-developed deliverables to enhance AI research.
 </li>
 <li>
 Diagnose and solve real issues in your domain to advance machine learning systems.
 </li>
 <li>
 Work independently and remotely on your own schedule.
 </li>
 <li>
 Contribute expertise to cutting-edge AI research.
 
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Must-Have
 
 
 
 <ul>
 <li>
 4+ years professional experience in nursing.
 </li>
 <li>
 Excellent written communication with strong grammar and spelling skills.
 
 
 
 </li>
 </ul>
 
 Start Date
 
 
 
 <ul>
 <li>
 Immediately
 
 
 
 </li>
 </ul>
 
 Application Process (Takes 20&ndash;30 mins to complete)
 
 
 
 <ul>
 <li>
 Upload resume
 </li>
 <li>
 AI interview based on your resume
 </li>
 <li>
 Submit form
 
 
 
 </li>
 </ul>
 
 Resources &amp; Support
 
 
 
 <ul>
 <li>
 For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
 </li>
 <li>
 For any help or support, reach out to: support@mercor.com
 
 
 
 </li>
 </ul>
 
 PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
 
</div>

Healthcare Specialist - Fully Remote

Aegis Health Services

<div>
 
 
 Company Description
 
 
 
 Aegis Health Services is dedicated to driving better patient outcomes through population health management. The organization focuses on improving healthcare delivery by ensuring that patients receive coordinated and comprehensive care. With a strong emphasis on quality, Aegis Health Services strives to create impactful and sustainable solutions in the healthcare industry.
 
 
 
 
 
 
 Role Description
 
 
 
 This is a full-time hybrid role for a Medical Billing Specialist based in Sandy Springs, GA, with the flexibility to work partially from home. We are looking for an organized and experienced medical billing specialist. The medical billing specialist will be responsible for multiple aspects of the revenue cycle and must be able to multitask, prioritize, and manage time efficiently.
 
 
 
 
 
 Duties will include but are not limited to:
 
 
 
 
 <ul>
 <li>
 Reviewing daily charges for accuracy by verifying patient and payor information on all patients and claims.
 </li>
 <li>
 Performing insurance verification and eligibility checks.
 </li>
 <li>
 Resolving payer specific and clearinghouse claim errors and rejections.
 </li>
 <li>
 Correcting and submitting claims to insurance companies.
 </li>
 <li>
 Working aged account receivables.
 </li>
 <li>
 Analyzing insurance remittances for posting payments and denials.
 </li>
 <li>
 Submitting required documentation for reimbursement.
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 3+ year of medical billing and coding
 </li>
 <li>
 Ability to verify patient benefits, analyze EOBs, determine appropriate codes for procedures performed, and post payments.
 </li>
 <li>
 Knowledge of CPT, HCPCS, and ICD-10 coding.
 </li>
 <li>
 Knowledge of Medicare, Medicaid, and other commercial health plans.
 </li>
 <li>
 Knowledge of EHR systems, spreadsheets, and word documents.
 </li>
 <li>
 Ability to work independently and manage multiple priorities.
 </li>
 <li>
 Ability to prioritize, organize, and exercise independent judgement and maintain confidentiality.
 </li>
 <li>
 Excellent analytical, verbal, and written communication skills.
 </li>
 </ul>
 
 
 
 
 **Salary compensation is based on experience**
 
 
 
 $24.00 - $28.00 per hour
 
 
</div>

Medical Billing Specialist

SearchPlus HR

<div>Job Title: Consultant Stroke Medicine - Leading Health Care Facility
SearchPlus HR is proud to partner with a leading healthcare facility in seeking a Consultant in Stroke Medicine. This role is pivotal in delivering advanced clinical care, leading multidisciplinary stroke teams, and developing innovative strategies to improve patient outcomes. As a Consultant, you will leverage your specialist knowledge to provide expert assessment, diagnosis, and management for patients with acute and chronic stroke conditions.
Key Responsibilities:<ul><li>
Provide expert clinical consultation in the management of stroke patients.</li><li>
Lead and coordinate multidisciplinary teams for stroke care and rehabilitation.</li><li>
Develop and implement evidence-based stroke treatment protocols and pathways.</li><li>
Conduct thorough patient assessments and diagnostic evaluations.</li><li>
Participate in clinical audits, research projects, and quality improvement initiatives.</li><li>
Educate patients, families, and medical staff on stroke prevention and management.</li><li>
Mentor and train junior medical staff and allied health professionals.</li><li>
Collaborate with other specialties to ensure comprehensive patient care.</li></ul> 

Requirements 
<ul><li>
Medical degree (MBBS/MD or equivalent) with specialist certification in Stroke Medicine.</li><li>
Significant experience as a Consultant or Specialist in Stroke Medicine, preferably within a leading healthcare institution.</li><li>
Strong clinical decision-making and leadership skills.</li><li>
Demonstrated expertise in multidisciplinary team collaboration.</li><li>
Excellent communication and interpersonal skills.</li><li>
Commitment to continuous professional development and research involvement.</li><li>
Ability to mentor and lead junior staff effectively.</li></ul> 

Benefits 
<ul>
<li>Private Health Insurance</li>
<li>Training &amp; Development</li>
<li>Performance Bonus</li>
<li>Private Health Insurance</li>
<li>Salary Range Qatar Riyal 52k -89k</li>
<li>Accommodation+ Paid Annual Leave +Air Tickets +Other benefits to family as well as.</li></ul></div>

Consultant Stroke Medicine Leading Health care Facility

Community Health Choice

Job Overview Under the direction of the Manager, Managed Care Pharmacy Operation, the Pharmacy Program Specialist II supports the operational needs of the pharmacy team by managing prior authorization processes, coordinating communication between members and providers, and addressing issues with the Pharmacy Benefit Manager (PBM). The role requires a strong understanding of medical benefit drug coverage and adherence to regulatory timelines. The specialist also contributes to reporting, monitoring delegated PBM functions, and promoting member adherence, while delivering a high level of customer service.QUALIFICATIONS:Required Preferred Education/Specialized Training/Licensure: Bachelor&rsquo;s degree in healthcare field, or in business administration Actively registered with the Texas State Board of Pharmacy as a certified pharmacy technicianWork Experience (Years and Area): Minimum Three (3) years&rsquo; experience with a Health Plan or PBM in related functions Strong experience with prior drug authorization process in a Health Plan or PBMPay: $23.46 - $29.32 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Houston, TX 77081

Pharmacy Program Specialist II

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