medical claims specialist

Progress Weight Management

<p><b>Medical Billing Specialist</b></p><p><b>Location:</b> Fargo, ND (In-Person)</p><p><b>Job Type:</b> Full-Time</p><p><b>Pay Range:</b> $18.00&ndash;$25.00 per hour</p><p><b>About the Role</b></p><p>We are seeking a detail-oriented and dependable <b>Medical Billing Specialist</b> to join our growing healthcare team in Fargo, North Dakota. This position plays a critical role in supporting the financial health of our organization by ensuring accurate claim submission, timely reimbursement, and exceptional patient service.</p><p>The ideal candidate has prior medical billing experience, strong problem-solving skills, initiative, and a collaborative work ethic. They are confident in working with insurance claims, billing processes, revenue cycle management, and EHR systems while contributing to a mission-driven healthcare organization.</p><p><b>Key Responsibilities</b></p><p><b>Claims Management &amp; Reimbursement</b></p><ul><li>Prepare, review, and submit accurate medical claims to commercial insurance carriers, Medicare, Medicaid, Tricare, and other third-party payers.</li><li>Audit claims for completeness and accuracy prior to submission.</li><li>Monitor claim status and perform follow-up on unpaid, delayed, denied, or rejected claims.</li><li>Research claim issues and coordinate appeals to maximize reimbursement.</li><li>Document all follow-up activities and claim actions within patient account records.</li></ul><p><b>Insurance Verification &amp; Eligibility</b></p><ul><li>Verify patient insurance eligibility and benefits prior to services.</li><li>Identify authorization and referral requirements when applicable.</li><li>Confirm coverage limitations and patient financial responsibility.</li></ul><p><b>Patient Billing &amp; Customer Service</b></p><ul><li>Generate and distribute patient statements.</li><li>Assist patients with billing questions, insurance explanations, account balances, and payment options.</li><li>Explain Explanation of Benefits (EOBs) and patient financial obligations in a professional manner.</li></ul><p><b>Payment Posting &amp; Account Reconciliation</b></p><ul><li>Post insurance payments, patient payments, contractual adjustments, and corrections accurately.</li><li>Reconcile account balances and investigate discrepancies.</li><li>Maintain accurate billing and payment records.</li></ul><p><b>Compliance &amp; Reporting</b></p><ul><li>Ensure compliance with HIPAA regulations and payer requirements.</li><li>Maintain confidentiality of patient information at all times.</li><li>Stay current on billing regulations, coding updates, and reimbursement guidelines.</li><li>Prepare reports and billing-related documentation as requested.</li></ul><p><b>Qualifications</b></p><p><b>Required</b></p><ul><li>High school diploma or equivalent.</li><li>Minimum 1&ndash;3 years of medical billing experience in a clinic, hospital, or healthcare billing environment.</li><li>Experience with medical billing software and Electronic Health Record (EHR) systems.</li><li>Knowledge of medical terminology and healthcare reimbursement processes.</li><li>Familiarity with ICD-10, CPT, and HCPCS coding systems.</li><li>Understanding of Medicare, Medicaid, commercial insurance, and coordination of benefits.</li><li>Strong attention to detail and organizational skills.</li><li>Excellent communication and customer service abilities.</li><li>Ability to multitask and prioritize work in a fast-paced environment.</li><li>Proficiency with computers.</li><li>Ability to maintain confidentiality and professionalism when handling sensitive information.</li></ul><p><b>Preferred</b></p><ul><li>Certified Professional Biller (CPB), Certified Billing &amp; Coding Specialist (CBCS), or similar credential.</li></ul><p><b>Benefits</b></p><ul><li>Medical, Dental &amp; Vision Insurance</li><li>Short Term Disability Insurance</li><li>Retirement</li><li>Paid Time Off (PTO)</li><li>Paid Holidays</li></ul><p>Pay: $18.00 - $25.00 per hour</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Medical Billing Specialist

Gainwell Technologies LLC

<div><div><div><div><div><p>Claims Specialist- Anchorage, AK (Hybrid)
</p></div></div></div></div><div><div><div><div><b>Date: </b>Jun 8, 2026
</div></div></div></div><div><div><div><div><b>Location:
</b>Any city, AK, US, 99999
</div></div></div></div><div><div><div><div><b>Req ID: </b>36193
</div></div></div></div><div><div><div><div><b>Work Mode: </b>Virtual (Exception only)
</div></div></div></div><div></div><div><div><div><div><div>Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.</div><div></div><div><div><div><div><b><br>
Summary</b></div>
</div><div><div>
As <b>Claims Specialist- Anchorage, AK (Hybrid)</b>, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve &mdash; a community&rsquo;s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare&rsquo;s biggest challenges. Here are the details on this position. HMS is hiring Claims Specialists to support our Alaska account. These positions processes moderately complex claims for our Alaska Medicaid client. They will make decisions on payment of medical claims using the existing policy and rules to ensure accurate and timely completion.</div></div></div><div></div><div><div><div><b><br>
Your role in our mission</b></div>
</div><div><ul><li>Review and research suspended medical claims and adjudicate them per DHS policy.</li>
<li>Refer claims to Utilization Review and Provider Services units.</li>
<li>Maintain necessary documentation.</li>
<li>Participate in meetings as necessary.</li>
<li>Participate in process improvement sessions.</li>
<li>Train as a back-up for other areas, such as document control, courier, and customer service desk.</li>
<li>Other duties as assigned</li>
</ul></div></div><div><div><div><b>What we're looking for</b></div>
</div><div><ul><li>Ability to work both independently and as part of a team.</li>
<li>Strong communication skills with the ability to communicate clearly and effectively in writing and verbally.</li>
<li>Ability to access and retrieve information using a PC.</li>
<li>Intermediate understanding of Microsoft Office products.</li>
<li>Organizational skills to balance and prioritize work, and analytical and problem-solving skills.</li>
</ul></div></div><div><div><div><b>What you should expect in this role</b></div>
</div><div><ul><li>Hybrid role with ability to work in the Anchorage, AK office preferred, with the possibility of working remotely from another state for the right candidate. The person will need to work Alaska Time hours.</li></ul><br>
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#LI-LS2</div>
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#LI-HYBRID</div></div></div></div><br>
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The pay range for this position is $37,500.00 - $53,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.</div><br>
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We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.</div><br>
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<div><i>
Gainwell Technologies </i><i>is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. </i><i>Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.</i></div></div></div></div></div></div><p></p>

Claims Specialist- Anchorage, AK (Hybrid)

The Cincinnati Insurance Companies

<div></div><div><div>US-OH-Fairfield<div>
</div></div><div><b>
Description</b><div></div><div><div><p><b><br>
Make a difference with a career in insurance</b></p><p>
At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we&rsquo;re looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person&reg;.</p><p>
If you&rsquo;re ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow.</p><p><b>
Build your future with us</b></p><div></div><div><br>
Our Claims Operations department is currently seeking a Claims Reporting Specialist II. The Claims Reporting Specialist is responsible for interpreting data requests (primarily statutory related), communicating with internal and external customers, and reporting claims data on a recurring basis. This individual will ensure data accuracy, completeness, and timely delivery of reports. This role contributes to continuous improvement efforts by identifying opportunities to enhance reporting processes, optimizing data quality, and partnering with data analysts to increase efficiency through automation and standardization.</div><div></div><div><b><br>
Starting pay:</b> The pay range for this position is $40,000 - $47,000 annually. Pay is based on the applicant&rsquo;s education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance.</div></div><p></p><div><p><b><br>
Be ready to:</b></p></div><div><ul><li><div>
Provide timely responses to data calls and other requests from states and regulatory entities</div></li></ul></div><div><ul><li><div>
Review and interpret statutory requests to identify procedures for compliance, eliciting input from other departments when needed</div></li></ul></div><div><ul><li><div>
Process and submit data to state regulatory entities related to medical malpractice, workers compensation, catastrophe-related data, or other claim related reporting for statutory bodies, agents, and/or insureds</div></li></ul></div><div><ul><li><div>
Independently extract data using various claims tools</div></li></ul></div><div><ul><li><div>
Collaborate with other analysts on the team and external customers to compile data and streamline processes</div></li></ul></div><div><ul><li><div>
Collaborate with other departments to ensure superior data quality across systems</div></li></ul></div><div><ul><li><div>
Prepare and coordinate data-related statutory audits</div></li></ul></div><div><ul><li><div>
Maintain efficient and effective processes by documenting and updating the steps for each unique reporting request</div></li></ul></div><div><ul><li><div>
Demonstrate autonomy to find resolution on reporting issues</div></li></ul></div><div><ul><li><div>
Assist with training and other reporting assignments as needed</div></li></ul></div><div></div><div><p><b><br>
Be equipped with:</b></p></div><div><ul><li><div>
keen attention to detail</div></li></ul></div><div><ul><li><div>
strong written and verbal communication skills</div></li></ul></div></div><div><div><ul><li><div>
strong analytical and problem-solving skills</div></li></ul></div><div><ul><li><div>
ability to understand and interpret reporting requirements written in a variety of formats</div></li></ul></div><div><ul><li><div>
understanding of internal claim applications and the relationship to reporting</div></li></ul></div><div><ul><li><div>
ability to comprehend technical and logical concepts and adapt quickly to changes</div></li></ul></div><div><ul><li><div>
fluency with Microsoft Excel</div></li></ul></div><div><ul><li><div>
ability to edit and execute queries in order to extract data</div></li></ul></div><div><ul><li><div>
comfortability to learn new tools</div></li></ul></div><div><ul><li><div>
superior time management skills to maintain own workflow, juggle multiple reports simultaneously, meet strict deadlines, and avoid fines/penalties</div></li></ul></div></div><div><div><b>
Bring education and experience from:</b></div></div><div></div><div><ul><li><div><br>
knowledge of insurance industry, including experience with claims or related insurance area</div></li></ul></div><div><ul><li><div>
2+ years of experience with workers&rsquo; compensation claims or reporting (claims or otherwise)</div></li></ul></div><div><ul><li><div>
ability to understand and interpret reporting requirements written in a variety of formats and jargons</div></li></ul></div><div><ul><li><div>
ability to work and communicate effectively with co-workers, external, and internal customers</div></li></ul></div><div><ul><li><div>
intermediate Microsoft Excel skills, including knowledge of vlookups, pivot tables, and other functionality</div></li><li><div>
Qualified candidates have 3+ years of relevant work experience, or an equivalent combination of education and experience</div></li></ul><div></div><p><b><br>
Enhance your talents</b></p><p>
Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you&rsquo;re new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional &ndash; all while enjoying a meaningful career.</p><p><b>
Enjoy benefits and amenities</b></p><p>
Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated.<b> </b>To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities.</p><p><b>
Embrace a diverse team</b></p><p>
As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation; gender identity and transgender status; religion; national origin; age; disability; military service, veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. about the Federal Employment Notices.</p></div></div></div>

Claims - Reporting Specialist II

State of Arizona

<div><div><div><div><div><ul><li>541302
</li></ul></div><div><ul><li>PHOENIX
</li></ul></div><div><ul><li>INDUSTRIAL COMMISSION
</li></ul></div><div><ul><li>Full-time
</li></ul></div><div><ul><li>Closing at: Jun 16 2026 - 23:55 MST
</li></ul></div></div><p></p><div><div><h1 class="jobSectionHeader"><b>INDUSTRIAL COMMISSION</b></h1>
<h2 class="jobSectionHeader"><b><i>Are you ready to work for an exceptional state agency that works to protect the life, health, safety, and welfare of the employees in the State of Arizona? Apply with us! The Industrial Commission of Arizona (ICA) is committed to the highest standards of compliance, demonstrating leadership in all areas, and teaching and working with employers and employees to make them successful. A thriving workforce in Arizona is what we strive for and work towards each day.</i></b></h2>
</div><h3 class="jobSectionHeader"><b>W/C INSURANCE CLAIMS SPECIALIST 2</b></h3>
<div>Job Location:
</div><div><h4 class="jobSectionHeader"><b>Address: Claims Division/Compliance Section</b><br>
<b>800 W. Washington Street, Phoenix, AZ 85007</b></h4>
</div><div>Posting Details:
</div><div><h4 class="jobSectionHeader"><b>Salary: $17.05 - $17.60</b><br>
<b>
</b></h4><h4 class="jobSectionHeader"><b>Grade: 17</b><br>
<b>
</b></h4><h4 class="jobSectionHeader"><b>Closing Date: June 16, 2026</b></h4>
</div><div>Job Summary:
</div><div><p>This position is responsible to audit incoming claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws.</p>
<p><i>
This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.</i></p>
<p><i>
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State&rsquo;s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.</i></p>
</div>
<div>Job Duties:
</div><div><div>Essential Duties and Responsibilities include but are not limited to:<br>
<ul><li>This position will critically analyze submitted forms for compliance and issue appropriate awards when indicated.</li><li>Audit insurance carriers, self-insured employers and third-party administrators adjusting workers&rsquo; compensation claims.
</li><li>Reviews all notices, attached medical and/or documentation to verify it supports current change of status and/or calculation of wage and awards. After analysis, specialist will issue correct corresponding award, notification, or document.
</li><li>Answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and the general public.
</li><li>Matches documents lacking information to existing Commission claims files by researching information in Claims database and for creating a new claim file for documents received when there is no existing claim file.</li><li>Provides backup assistance to data entry, error resolution, insurance or combine/delete, as requested and
</li><li>Participates in Arizona Management System (AMS) and daily Huddle board.</li><li>Attends staff meetings, seminars, conferences, training classes.</li></ul></div></div><br>
<div>
Knowledge, Skills &amp; Abilities (KSAs):
</div><div><div>Knowledge in<br>
<ul><li>Basic knowledge or ability to learn of applicable workers compensation claims management laws, statutes, and case laws.
</li><li>Basic Medical terminology.
</li><li>Microsoft Office Suite; Outlook, Word, Excel, Google Office Suite, Gmail, Sheets and Docs</li><li>Basic English</li><li>Basic Mathematics</li><li>The insurance industry claims adjusting standards and practices.
</li></ul><ul><li>Skill in:</li><li>Communicating verbally and in writing to resolve disputes with interested parties.
</li><li>Basic analysis of insurance, medical and legal documents.
</li><li>Reviewing and interpreting Arizona Workers' Compensation laws, rules, procedures, and court decisions</li><li>Critical thinking</li><li>Time Management</li><li>Initiative and attention to detail</li><li>Customer service</li><li>Organizing and planning</li><li>Basic Business process acumen, management skills including workflows and information management.
</li></ul><ul><li>Ability to:</li><li>Interpret medical records to determine physical limitations for injured workers.</li><li>Manage heavy workload with high level of accuracy and production.</li><li>Learn computer systems and applications.</li><li>Work well within a diverse and inclusive office environment.</li><li>Process documents in a timely manner and within established productivity standard.</li><li>Prioritizes work within established time frames.</li><li>Manage time effectively and meet deadlines.</li><li>Adapt to changing circumstances.</li><li>Demonstrate initiative and attention to detail.</li><li>Exercise discretion and judgment.</li><li>Works well under pressure.</li><li>Perform job responsibilities incorporating lean management and principles of the Arizona Management System.</li><li>Produce high quality, nearly error-free output.</li></ul></div></div><br>
<div>
Selective Preference(s):
</div><div><p>The ideal candidate for this position will have:<br>
Claims adjusting license, certification (WCCA, WCCP, CPCU) or designation relating to workers' compensation.</p><br>
</div>
<div>Pre-Employment Requirements:
</div><div><p><i>All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).</i></p>
</div>
<div>Benefits:
</div><div><p>The Arizona Department of Administration offers a comprehensive benefits package to include:
<br>
Sick leave<br>
Vacation with 10 paid holidays per year<br>
Health and dental insurance<br>
Retirement plan<br>
Life insurance and long-term disability insurance<br>
Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance</p><br>
<p><i>
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.</i></p>
<p><i>
For a complete list of benefits provided by The State of Arizona, please visit our </i><i>benefits page</i></p>
</div>
<div>Retirement:
</div><div><p>You will be eligible to participate in the state employee health/disability insurance plan, and you are required to participate in the Arizona State Retirement System (ASRS). ASRS participation may begin immediately or upon your 27th week of employment. Contributions are matched by the employer.</p>
</div>
<div>Contact Us:
</div><div><p>If you have any questions please feel free to call 602-542-5559 or email HR@azica.gov for assistance.</p></div></div></div></div></div>

W/C INSURANCE CLAIMS SPECIALIST 2

Total Orthopedics & Sports Medicine

<p>We are seeking a dedicated <b>Medical Billing AR Specialist</b> with a strong background in managing accounts receivable billing and collection of payments for all designated payors and locations in order to meet and maintain our goal to join our dynamic team.<br/>You will be responsible for transferring patient and insurance information and initiating payment processes and procedures. The ideal candidate will be well-versed in billing software, medical insurance regulations, and an expert at responding to patient and insurance inquiries. You will also be responsible for maintaining patient confidentiality, handling personal information, and accurately inputting patient data into the system.</p><p><b>Responsibilities:</b></p><ul><li>Identifies and resolves billing inquiries/problems</li><li>Codes services provided utilizing CPT and ICD-10 coding</li><li>Experience with Medicare, Commercial, Worker's Comp and No-Fault claims follow up</li><li>Knowledge of Medical Terminology, ICD-10, CPT codes and the correct use of modifiers</li><li>Working rejections from the clearinghouse to correct errors for resubmissions</li><li>Generates and submits electronic claims and statements at designated intervals; corrects any errors for complete and accurate transmission of data</li><li>Able to handle patient inquiries regarding billing issues, out of network issues, and explaining insurance guidelines to patients</li><li>Read and analyze patient records to determine correct codes for billing to insurance provider</li><li>Prepares letters of appeal to insurance companies if the company refuses to pay contracted claims and/or denies a claim; submits documentation necessary to support claim; resubmits claims with corrections if needed for payment for all insurance payers</li><li>Researches and processes refund requests and overpayments</li><li>Prepares correspondence and/or collection letters</li><li>Performs other related duties as assigned by senior management</li></ul><p><b>Requirements:</b></p><ul><li>Proficiency in medical terminology and ICD-9 / ICD-10 coding</li><li>Experience with insurance verification and prior authorizations</li><li>Strong attention to detail and data entry accuracy</li><li>Excellent communication and organizational skills</li></ul><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Disability insurance</li><li>Health insurance</li><li>Company paid Life insurance and optional voluntary insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: In person: Relocate before starting work (Required)</p><p>Our company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, sexual orientation, gender identity, or gender expression in terms of all conditions of employment. Our diversity is one of our greatest strengths, and as an Equal Opportunity Employer, we are proud to promote a work environment where all differences are respected.</p><p>Job Type: Full-time</p><p>Pay: $25.00 - $28.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Health savings account</li><li>Paid time off</li><li>Parental leave</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>Medical billing: 1 year (Preferred)</li></ul><p>Ability to Commute:</p><ul><li>Syosset, NY 11791 (Required)</li></ul><p>Work Location: In person</p>

Medical Billing Accounts Receivable (AR) Specialist

Foundation Laboratory

<p>We are seeking Full-Time Billers/Claims Collections Specialist to join our team!</p><p><b>Qualifications:</b></p><ul><li>Minimum two years of experience as a Biller is preferred.</li><li>Laboratory Billing Experience Preferred.</li><li>Correct, appeal and resubmit denied claims or charges.</li><li>Audit patient accounts for proper billing and status.</li><li>Verify, update/edit and approve charges for billing.</li><li>Contact clients or patients regarding account information, diagnosis or verification of payer information.</li><li>Provide customer service to clients or patients in regards to their account balance, statement, pricing and collection of payment.</li><li>Knowledge of ICD-10, NCD/LCD and NCCI guidelines.</li><li>Regular, reliable and predictable attendance required.</li><li>Related experience in a laboratory setting is a plus.</li><li>Bilingual - Spanish is a plus.</li></ul><p><b>Desired Attributes:</b></p><ul><li>Ability to multitask</li><li>Strong interpersonal skills</li><li>Ability to function with the highest level of quality and care</li><li>Strong organizational skills</li></ul><p>Job Type: Full-time</p><p>Pay: $19.00 - $22.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Biller/Claims Specialist

Commonwealth of Pennsylvania

<div>JOB As a Third Party Liability Specialist in the Department of Human Services, you will take on meaningful work that helps recover funds and uphold accountability. This position gives you the chance to review complex information and collaborate with partners across the state. You will join a team that values initiative, accuracy, and thoughtful decision making. Bring your skills to a role that makes a real difference in protecting public programs!<br>
<br>
EXAMPLE OF DUTIES
<p>
This position focuses on evaluating potential claims, identifying responsible parties, and supporting the recovery of medical assistance funds. As a Third Party Liability Specialist, you will perform the following duties:</p><ul><li><b>
Claim Review: </b>Analyze referrals and determine whether benefits were issued incorrectly</li><li><b>
Case Investigation: </b>Collect information from attorneys, insurers, providers, and other parties to support claim decisions</li><li><b>
Regulation Research: </b>Interpret state and federal laws to guide claim analysis and determine responsible parties</li><li><b>
Settlement Negotiation: </b>Discuss cases with interested parties and recommend fair settlement amounts</li><li><b>
Record Maintenance: </b>Maintain accurate case files and document important updates for future reference</li><li><b>
Data System Use: </b>Access and interpret information in electronic systems to support claim assessments</li></ul><br>
Interested in learning more? Additional details regarding this position can be found in the position description.<div></div><div><b><br>
Work Schedule and Additional Information:</b></div><ul><li>
Full-time employment, 37.5 hours per week</li><li>
Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.</li><li><b>
Telework: </b>You may have the opportunity to work from home (telework) part-time up to 3 days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview.</li><li><b>
Salary:</b><b><i> </i></b>In some cases, the starting salary may be non-negotiable.</li><li>
FREE parking!</li><li>
You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.</li></ul>
SUPPLEMENTAL INFORMATION
<ul><li>Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).</li><li>
Your score is based on the detailed information you provide on your application and in response to the supplemental questions.</li><li>
Your score is valid for this specific posting only.</li><li>
You must provide complete and accurate information or:<ul><li>
your score may be lower than deserved.</li><li>
you may be disqualified.</li></ul></li><li>
You may only apply/test <b>once</b> for this posting.</li><li>
Your results will be provided via email.</li></ul></div>

Third Party Liability Specialist

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