healthcare claims specialist

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview<div> 
Salary: Salary for this position could go up to $119,000 per year, dependent upon experience.</div><div><div>
Jurisdictions: Open to any</div><div>
Licenses: Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
Location: This role is eligible for fully remote work</div><div></div><div> 
The Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims, with a primary focus on Correctional Medicine. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div></div>
 
How you'll make an impact 
<ul><li>
Analyzes coverage and settles moderately complex claims in Correctional Medicine Professional Liability.</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
 
About You<div> 
Required:</div><ul><li><div>
Bachelor&rsquo;s degree required</div></li><li><div>
Minimum 2+ years of experience in handling professional liability claims</div></li><li><div>
Strong insurance fundamentals and understanding of claims processes.</div></li><li><div>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</div></li><li><div>
Computer proficiency with claims systems and standard business software.</div></li><li><div>
Must be able to obtain required adjuster licenses within designated timeframes.</div></li></ul><div>
Preferred:
</div><ul><li>Prior experience within healthcare, medical malpractice, or correctional medicine claims a plus.</li><li>
Strong insurance background (carrier, TPA, brokerage, or claims support experience).</li><li>
JD preferred but not required</li></ul><div>
Behaviors:</div><div><ul><li>
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, and communicate effectively in writing and verbally.</li><li>
Strong analytical skills to support claims decisions and issue resolution.</li><li>
Ability to interpret policies, records, and related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div></div>

Claim Specialist - Correctional Medicine

AdaptHealth

<div>Description:

AdaptHealth Opportunity &ndash; Apply Today!
At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives &ndash; out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients&rsquo; lives, please click to apply, we would love to hear from you.
PAP Specialist
The PAP Specialist has a broad range of responsibilities including accurate and timely data entry, understanding, and selecting inventory and services in key databases, communicating with referral sources, and appropriately utilizing technology to notate patient information/communication. Intake Specialist&rsquo;s schedules can vary based on the need of the branch. Hours can range anywhere between 8am and 7pm 7 days/week.
Responsible for ensuring customers receive PAP equipment by scheduling an appointment for the customer to come in to pick up equipment and receive proper instruction on how to best use the equipment. Explains customers financial responsibility and ensure payment.
PAP Specialists are responsible for preparing and submitting audit paperwork for Medicare and other insurance claims to ensure continued compliance with healthcare guidelines. The PAP Specialist will accurately respond to claim audits and communicate audit results in such a way to provide education and appropriate process changes that directly impact the daily functions of AdaptHealth.
Responsible for monitoring, communicating, and managing all clients on Positive Airway Pressure devices. Responsible for encouraging client compliance with PAP equipment and program.
Job Duties:<ul><li>
Develop and maintain working knowledge of current HME products and services offered by the company and all applicable insurance guidelines respecting eligibility for coverage and reimbursement.</li><li>
Is actively involved in team activities, evidenced by participation, mentoring, and training with co-workers</li><li>
Assists in the development and maintenance of reference materials for use by staff and facilitates the sharing of information</li><li>
Develops relationships with branches, other teams to accomplish goals</li><li>
Participates in monthly team meetings and trainings</li><li>
Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification</li><li>
Collaborates with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentation as well as educating, as necessary.</li><li>
Identify trends and providing feedback and education to internal and external customers on compliant documentation requirements for services provided.</li><li>
Maintain patient confidentiality and function within the guidelines of HIPAA</li><li>
Completes assigned compliance training and other educational programs as required</li><li>
Maintains compliant with AdaptHealth&rsquo;s Compliance Program</li><li>
Other duties as assigned.</li></ul>
Requirements:

Minimum Job Qualifications:<ul><li>
High School Diploma or equivalent</li><li>
One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.</li><li>
Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.</li><li>
Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.</li></ul>
AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual&rsquo;s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.</div>

PAP Specialist

SNQ Herbal

Are you a healthcare enthusiast with a talent for navigating the world of medical insurance? Med-Right LLC is looking for a proactive Medical Claims Coordinator to join our expanding team in Doha. This is more than just a desk job&mdash;it is an opportunity to be the vital link between patients, providers, and insurance companies. If you thrive on accuracy, enjoy problem-solving, and want to work in an environment that values professional growth, we want to hear from you.About the CompanyMed-Right LLC is a premier Third-Party Administrator (TPA) and healthcare management firm dedicated to making healthcare accessible and transparent. With a network of thousands of providers and a reputation for leveraging high-end technology, we simplify complex medical processes. At Med-Right, we believe that a healthy life is a happy life, and we work tirelessly to ensure our beneficiaries get the right care at the right time.Why Work With Us?<ul><li>Professional Growth: We provide regular training on the latest medical coding (ICD-10, CPT) and AI-driven claims processing tools.</li><li>Supportive Environment: Join a multicultural team that values respect, teamwork, and collaborative success.</li><li>Modern Benefits: Competitive tax-free salary, comprehensive private health insurance, and annual air ticket allowance.</li><li>Stability: Work with an ISO-certified organization that is a leader in the Middle Eastern healthcare sector.</li></ul>Key Responsibilities<ul><li>Review and evaluate medical claims for eligibility, accuracy, and compliance with insurance policies.</li><li>Coordinate with healthcare providers to obtain missing documentation or clarify billing discrepancies.</li><li>Process prior authorization requests and respond to inquiries from insurance companies and clients.</li><li>Monitor claims status and identify trends in denials to suggest process improvements.</li><li>Ensure all data entry is handled with high precision within our Claims Management System.</li><li>Maintain strict confidentiality of patient records in accordance with healthcare regulations.</li></ul>Skills and Requirements<ul><li>Education: Bachelor&rsquo;s degree in Pharmacy, Nursing, Medicine, or a related healthcare field.</li><li>Technical Skills: Proficiency in MS Office (especially Excel) and familiarity with medical coding systems (ICD-10/CPT).</li><li>Communication: Excellent verbal and written communication skills in English; Arabic is a plus.</li><li>Analytical Mindset: Strong attention to detail and the ability to spot errors in complex medical invoices.</li><li>Adaptability: Comfortable working in a fast-paced environment and learning new digital health tools.</li><li>Experience: 1&ndash;2 years in medical claims, insurance coordination, or a TPA setting is preferred, though motivated fresh graduates are welcome to apply.</li></ul>Join Our Team TodayReady to take the next step in your healthcare administration career? We have simplified our application process to respect your time. Click the apply button to submit your CV and join a company that is shaping the future of healthcare management in Qatar.Apply Now and start your journey with Med-Right LLC.Med-Right LLC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.الراتب المدفوع: QAR٥٬٠٠٠٫٠٠&nbsp;لكل شهرموقع العمل: بشكل شخصي

Herbal Products Coordinator

Optum

<div>This position follows a hybrid schedule with employees will be required to work some days onsite and some days from home. Our office is located at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will support timely processing of the member's claim.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.
We offer 90 days of online and onsite on the job training aligned to your schedule. 
Primary Responsibilities:<ul><li>
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims</li><li>
Analyze and identify trends and provide reports as necessary</li><li>
Consistently meet established productivity, schedule adherence and quality standards</li><li>
Other duties as assigned</li></ul> 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR older</li><li>
1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.), using phones and computers as the primary job tools</li><li>
Experience using computers and Windows based applications, which includes the ability to learn new and complex computer system applications</li><li>
1+ years of experience using Microsoft Office applications</li><li>
1+ years of experience with processing medical, dental, prescription, OR mental health claims</li><li>
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.</li></ul> 
Telecommuting Requirements:<ul><li>
Reside within commutable distance to the office at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108</li><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.</li></ul> 
Soft Skills:<ul><li>
Ability to work independently and prioritize tasks</li><li>
Display strong work ethic, independence, and dependability</li><li>
Exhibit excellent time management, organizational, and prioritization skills</li><li>
Demonstrate the ability to multitask</li><li>
Possess effective interpersonal, influence, collaboration, and listening skills</li><li>
Drive for results individually and in a team setting</li></ul> 
<ul><li>All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO</div>

Claims Representative

Simpson General Hospital

<div>Join Our Team at Simpson General Hospital!
Position: Medical Billing Specialist 
Location: Business Office Financial Services 
Schedule: MondayFriday | 8:00 AM 4:30 PM | Full-Time 
Reports to: Business Office Director
At Simpson General Hospital (SGH), we pride ourselves on delivering high-quality healthcare in a warm, hometown environment. We're currently seeking a Medical Billing Specialist to join our Financial Services team. If you're detail-oriented, experienced in healthcare billing, and passionate about supporting patient care behind the scenes, we'd love to hear from you!<h3 class="jobSectionHeader">
Position Summary:</h3>
The Medical Billing Specialist is responsible for preparing insurance claims, following up on denials, and ensuring accurate billing through patient demographic and insurance updates. This role involves regular communication with patients, families, insurance companies, and internal departments.<h3 class="jobSectionHeader">
Essential DutiesResponsibilities:</h3><ul><li>
Edit and submit UB and 1500 claim forms</li><li>
File insurance claims and follow up on billing work queues</li><li>
Correct and rebill claims as needed</li><li>
Assist with claims data for audits</li><li>
Provide excellent customer service</li><li>
Demonstrate professionalism aligned with SGH's mission and values</li><li>
Comply with HIPAA, infection control, and safety guidelines</li><li>
Perform other duties as assigned</li></ul><h3 class="jobSectionHeader">
Qualifications:</h3><ul><li>
Education: High School Diploma or GED (Required); Associate degree (Preferred)</li><li>
Experience: 
<ul><li>
35 years in a healthcare billing/business office setting (Preferred)</li><li>
Proficiency in Microsoft Word, Excel, and customer service</li></ul></li><li>
Strong communication and interpersonal skills</li><li>
Knowledge of claims submission for Medicare, Medicaid, and major insurers</li><li>
Efficient data entry and reconciliation skills</li><li>
Ability to work independently and meet deadlines under pressure</li><li>
Familiarity with healthcare laws and regulations</li></ul><h3 class="jobSectionHeader">
Physical Requirements:</h3><ul><li>
Clear speech and hearing for effective communication</li><li>
Visual acuity for close and distant tasks</li><li>
Occasionally lift up to 25 lbs.</li></ul><h3 class="jobSectionHeader">
Benefits Include:</h3><ul><li>
Health Insurance</li><li>
Dental Insurance</li><li>
Vision Insurance</li><li>
Company-paid Life and AD&amp;D Insurance</li><li>
Supplemental Insurance Options</li><li>
403(b) Retirement Plan</li><li>
Paid Time Off (PTO)</li><li>
Sick Time Off (STO)</li><li>
Discounted In-House Services at SGH ClinicsHospital</li></ul><h3 class="jobSectionHeader">
Ready to Apply?</h3>
Be part of a team that values accuracy, compassion, and community care. Apply today and help us continue providing exceptional service to our patients and families!</div>

Billing Specialist

Addison Group

Job Overview We are seeking a dynamic and detail-oriented Medical Billing Specialist to join our healthcare team. In this vital role, you will be responsible for managing the entire billing process, ensuring accurate coding, timely submission of claims, and effective follow-up on outstanding accounts. Your expertise will help optimize revenue cycle management while maintaining compliance with industry standards. This position offers an exciting opportunity to contribute to efficient healthcare delivery through precise medical billing practices.Responsibilities<ul><li>Prepare and submit insurance claims using appropriate coding systems such as CPT (Current Procedural Terminology), ICD-9, and ICD-10 codes.</li><li>Review medical records and documentation to ensure accuracy and completeness for billing purposes.</li><li>Verify patient insurance coverage and eligibility before submitting claims.</li><li>Follow up on unpaid or rejected claims through effective medical collection strategies.</li><li>Maintain detailed records of billing activities within Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems.</li><li>Collaborate with healthcare providers to clarify diagnoses or procedures requiring accurate DRG (Diagnosis-Related Group) coding.</li><li>Ensure compliance with healthcare regulations and industry standards related to medical coding and billing.</li></ul>Requirements<ul><li>Proven experience in medical office settings or healthcare billing environments.</li><li>Strong knowledge of medical terminology, medical records management, and billing procedures.</li><li>Familiarity with DRG, CPT coding, ICD-9, ICD-10, and ICD coding systems.</li><li>Experience working with EMR/EHR systems for documentation and billing purposes.</li><li>Excellent attention to detail and organizational skills to manage multiple claims efficiently.</li><li>Ability to interpret complex medical documentation and translate it into accurate billing codes.</li><li>Effective communication skills to coordinate with providers, insurance companies, and patients. Join our team as a Medical Billing Specialist and play a crucial role in ensuring smooth financial operations while supporting quality patient care!</li></ul>Pay: $34.39 - $59.37 per hourBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Retirement plan</li></ul>Work Location: In person

Medical Billing Specialist

Renown Health

<div>
 
 Position Purpose
 
 
 
 The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.
 
 
 
 Nature and Scope
 
 
 
 
 The Insurance And Claims Specialist Is Responsible For
 
 
 
 <ul>
 <li>
 Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.
 </li>
 <li>
 Audit denials and payment variances to determine root cause and correction as required.
 </li>
 <li>
 Auditing payment variances ensuring appropriate reimbursement.
 </li>
 <li>
 Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.
 </li>
 <li>
 Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.
 </li>
 <li>
 Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.
 </li>
 <li>
 Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.
 
 
 </li>
 </ul>
 This position is required to operate within policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with Renown Health goals and objectives.
 
 
 This position does not provide patient care.
 
 
 
 Disclaimer
 
 
 
 The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
 
 
 
 Minimum Qualifications
 
 
 
 Requirements - Required and/or Preferred
 
 
 
 Name
 
 
 
 
 Description
 
 
 
 Education:
 
 
 Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.
 
 
 
 Experience
 
 
 
 One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.
 
 
 
 License(s)
 
 
 
 None.
 
 
 
 Certification(s)
 
 
 
 None.
 
 
 
 Computer / Typing
 
 
 
 Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
</div>

Insurance and Claims Specialist

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