medical claims specialist

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

CodeMax Medical Billing

<div>Reports to: Claims Supervisor
Employment Status: Full-Time
FLSA Status: Non-Exempt
Work Location: On-site - Fort Lauderdale, FL
Job Summary:
To ensure a timely and accurate collection of medical claims. The Claims Specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims.
Duties/Responsibilities:<ul><li>
Reviews and work on unpaid claims, identifying and rectifying billing issues.</li><li>
Communicate with insurance companies regarding any discrepancy in payments if necessary.</li><li>
Conducts research and appeals denied claims timely.</li><li>
Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons.</li><li>
Provides detailed notes on actions taken and the next steps for unpaid claims.</li><li>
Collaborate with the billing team to ensure accurate claim submission.</li><li>
Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements.</li><li>
Resubmits claims with necessary corrections or supporting documentation when needed.</li><li>
Tracks and documents trends related to denials and work towards a resolution with the billing team.</li><li>
Assist patients with inquiries related to their insurance claims, providing clear and accurate information.</li><li>
All other duties assigned by the department supervisor and/or management team.</li></ul>
Required Skills/Abilities:<ul><li>
Proficiency in healthcare billing software.</li><li>
Strong analytical, organizational, and multitasking skills.</li><li>
Excellent verbal and written communication abilities.</li><li>
Ability to navigate payer websites and use online resources to resolve outstanding claims.</li></ul>
Education and Experience:<ul><li>
High school diploma or equivalent required.</li><li>
Prior experience in medical billing collections or a similar role.</li><li>
Knowledge of medical terminology, CPT and ICD-10 coding is a plus.</li><li>
Knowledge of HIPAA and other healthcare industry regulations.</li></ul>
Benefits<ul><li>
Health Insurance</li><li>
Vision Insurance</li><li>
Dental Insurance</li><li>
401(k) plan with matching contributions</li></ul>
CodeMax is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
CodeMax is a participating employer in the federal E-Verify program.</div>

Claims Follow-Up Specialist

Oak Harbor Freight Lines

Auto & Property Claims Specialist I
 
Oak Harbor Freight Lines is an established, successful regional trucking company operating in Washington, Oregon, Idaho, Nevada, Utah, Arizona, and California. As a premier carrier offering superior service, we are always interested in exceptional people with excellent skills who strive to achieve their best. We are searching for an energetic and upbeat individual to join our team as an Auto & Property Claims Specialist I.
 
The Auto & Property Claims Specialist I will be responsible for overseeing and managing driver and accident claims from initial report through resolution. This position involves a dynamic combination of managing driver incidents, accident claims, and identifying subrogation opportunities. A successful candidate will thrive in an environment that requires multitasking, investigation, information gathering, and detailed record keeping—often moving multiple claims forward simultaneously.
 
Duties include reviewing police reports, gathering photos and documentation, and preparing key
 materials for the review board’s determination. This position will work closely with the shop
 managers, operations leaders, and the Human Resources and Safety departments.
 
Essential Duties and Responsibilities: 
<ul>
<li>Manage and process accident claims from start to finish</li>
<li>Collect and process internal accident reports, including ensuring the preventable/non-preventable ruling is made timely and sent to the Terminal Manager for handling.</li>
<li>Coordinate with multiple departments to gather required documents</li>
<li>Document conversations and e-mail correspondence</li>
<li>Follow up on opening activities</li>
<li>Check claims for validity and accuracy</li>
<li>Identify and pursue subrogation opportunities, including gathering supporting documentation and coordinating recovery efforts</li>
<li>Perform other duties as assigned.</li>
</ul>
Skills, Experience, and Educational Requirements
 <ul>
<li>High School diploma/GED equivalent or higher</li>
<li>Claims or insurance experience preferred, but not required</li>
<li>Effective analytical skills to gather information, analyze facts, and make recommendations based on information collected.</li>
<li>Strong oral and written communication skills, with the ability to convey information clearly and concisely</li>
<li>Excellent time management and organizational skills</li>
<li>Strong PC skills, including Microsoft Office</li>
<li>Multi-task ability as well as detail-oriented</li>
<li>Customer service-focused</li>
<li>Ability to work independently with minimal supervision as well as collaboratively in a team environment</li>
<li>Basic English language proficiency (reading, writing, and verbal) is required.</li>
</ul>
Benefits
 <ul>
<li>Medical, dental, vision – You choose which plan suits you and our family.</li>
<li>Employee only pays 0% up to 2% of gross income.</li>
<li>Family pays 0% up to 4% of gross income.</li>
<li>401K – 100% match up to 5% of employee's contribution.</li>
<li>Accrue 80 hours of PTO within the first 11 months and 120 in your second year.</li>
<li>Holiday pay after your 90 days.</li>
<li>Company Paid Life Insurance.</li>
</ul>
http://www.oakharborbenefits.com/full-time-regular-employees.html
 Oak Harbor Freight Lines is an Equal Opportunity Employer

Auto & Property 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 can be up to $120,000 per year, dependent upon experience</div><div>
Claims Background: Professional Liability Claims, Paralegal experience, or related insurance support role 
Jurisdictional Experience: Open to any 
Active Adjuster Licenses: Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
</div><div>
The Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims. 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>
 
How you'll make an impact 
<ul><li>
Analyzes coverage and settles moderately complex claims in Healthcare 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>
Claims Background: Paralegal experience, junior professional liability claims experience, or insurance claims support background, preferably within healthcare or medical professional liability</div><div>
Jurisdictional Experience: Open to any 
Active Adjusters&rsquo; Licenses: Not required initially; must be willing to obtain licenses as directed</div><div></div><div> 
Required:</div> 
<div></div><ul><li>
Bachelor's Degree Required</li><li>
Minimum 2 years of experience in claims, insurance, paralegal, legal support, or a related environment.</li><li>
Strong insurance fundamentals and understanding of claims processes.</li><li>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</li><li>
Computer proficiency with claims systems and standard business software.</li><li>
Must be able to obtain required adjuster licenses within designated timeframes.</li></ul><div> 
Preferred:</div><ul><li>
Prior experience within healthcare (medical malpractice) claims is a plus</li></ul><div>
Behaviors:<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><div></div>

Claim Specialist - Healthcare Professional Liability

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

The Plastic Surgery Center

The Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates are the largest Reconstructive Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing superior patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees&mdash;whether caring for patients directly or working in a support role.We are seeking a Claims Dispute Specialist.The Claims Dispute Coordinator manages and resolves complex medical claim disputes and appeals with a focus on compliance with the Federal No Surprises Act (NSA) and similar state surprise billing laws. This role requires strong written communication skills, analytical skills and attention to detail. The ideal candidate brings the ability to efficiently prepare strong written arguments based on complex medical claims while effectively managing dispute process deadlines.Key Responsibilities <ul><li>Review and analyze medical claims to ensure accuracy, compliance, and eligibility for appeal or dispute under the NSA or state law</li><li>Investigate claim payments and denials by reviewing clinical documentation, insurance payer contracts, and claim history</li><li>Initiate and manage disputes under the NSA or state law</li><li>Prepare clear and effective written arguments as part of claims dispute processes</li><li>Analyze data and identify insights to support negotiations and dispute arguments</li><li>Collaborate with various teams within ARSA to ensure timely and successful dispute resolution</li></ul>Qualifications and Experience <ul><li>1&ndash;3 years in healthcare claims processing preferred</li><li>Experience with No Surprises Act dispute resolution highly preferred</li><li>Bachelor&rsquo;s degree relevant field preferred</li></ul>Skills <ul><li>Strong analytical and problem-solving abilities</li><li>Strong written and verbal communication skills</li><li>Strong organization skills</li><li>Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li><li>Proficiency in Microsoft Office suite and healthcare practice management systems</li></ul>Compensation &amp; Benefits:<ul><li>&middot; Pay Range: $55,000- $60,000annually</li><li>the starting rate within this range for this role varies depending on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies, experience, and location.</li><li>&middot; Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance</li><li>&middot; 401k and Profit sharing</li><li>&middot; Paid Time Off</li><li>&middot; Contribution to Health Benefits</li><li>Company Discounts on Products &amp; Services</li></ul>IND2Job Type: Full-timePay: $55,000.00 - $60,000.00 per yearExperience:<ul><li>Medical claims processinfg: 2 years (Required)</li><li>No Surprises Act: 2 years (Required)</li></ul>Ability to Commute:<ul><li>Red Bank, NJ 07701 (Required)</li></ul>Work Location: In person

Claims Dispute Specialist

Nationwide

<div>
 If you&rsquo;re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide&rsquo;s Property and Casualty team could be the place for you! At Nationwide&reg;, &ldquo;on your side&rdquo; goes beyond just words. Our customers and partners are at the center of everything we do and we&rsquo;re looking for associates who are passionate about delivering extraordinary care.
 
 
 
 Job Description Summary
 
 
 
 If you can put your keen legal mind to work analyzing, managing and resolving insurance coverage and claims, we want to know more about you! Working on our team offers the opportunity to be involved in settling litigated and non-litigated claims of low to moderate complexity and severity in terms of exposure and coverage.
 
 
 As a Claims Specialist, you'll investigate, evaluate and negotiate claims to successful resolution. This role supports the management liability and specialty lines of business, including errors and omissions, directors and officers and employment practices liability. You will have low monetary authority and work under limited direct supervision and monitoring. We will count on you to collaborate and provide insight to our business partners on claims and policy wording questions and maintain, develop and influence relationships with customers and business partners.
 
 
 
 Job Description
 
 
 
 
 Key Responsibilities:
 
 
 
 <ul>
 <li>
 Investigates and evaluates coverage, liability and damages to set an appropriate claim strategy, settlement and file reserves within approved claims authority.
 </li>
 <li>
 Provides timely and appropriate evaluation of claims to identify and manage reserves in compliance with company standards.
 </li>
 <li>
 Analyze coverage and provide comprehensive coverage analysis and claim resolution strategies.
 </li>
 <li>
 Provide feedback on claim trends and development. Provide input to underwriters on review of potential and existing insured&rsquo;s claim experience.
 </li>
 <li>
 Delivers outstanding customer service and satisfaction through effective interactions with insured, agents, and legal counsel.
 </li>
 <li>
 Maintains current knowledge of applicable lines of insurance, insurance regulations, court decisions which may impact the claims function, current guidelines and policy changes and modifications. This may require attending various seminars and training sessions.
 </li>
 <li>
 Contributes to a collaborative environment by consistently demonstrating teamwork, motivation, positive behavior and effort to achieve goals and objectives.
 
 
 </li>
 </ul>
 
 May Perform Other Responsibilities As Assigned.
 
 
 
 
 Reporting Relationships:
 
 Reports to Claims Director, Freedom Specialty
 
 
 
 Typical Skills And Experiences
 
 
 
 
 Education:
 
 College degree preferred. Juris Doctorate desired.
 
 
 
 License/Certification/Designation:
 
 Associates must acquire the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to acquire required licenses/registrations within the designated time period, the associate will be ineligible to continue in the position.
 
 
 
 Experience:
 
 Typically, two to four years of claims handling experience. Prior experience in directing defense counsel required. Specific experience in a specific line of business may be required by the hiring business unit.
 
 
 
 Knowledge, Abilities and Skills:
 
 Specific knowledge in a particular line of business and/or additional education may be required. Familiarity with various types of insurance policies preferred. The ability to evaluate and interpret information, strong written and verbal communication skills, the ability to multi-task, strong time management and organizational skills, the ability to effectively and efficiently manage all responsibilities.
 
 
 Other criteria, including leadership skills, competencies and experiences may take precedence.
 
 
 Staffing exceptions to the above must be approved by the hiring manager&rsquo;s leader and HR Business Partner.
 
 
 
 Values:
 
 Regularly and consistently demonstrates the Nationwide Values.
 
 
 
 Job Conditions
 
 
 
 
 Overtime Eligibility:
 
 Not Eligible (Exempt)
 
 
 
 Working Conditions:
 
 Normal office environment
 
 
 
 ADA:
 
 The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
 
 
 
 Credit/Background Check:
 
 Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
 
 
 
 Benefits
 
 
 
 We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.
 
 
 Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.
 
 
 #claims
 
 
 For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf
 
 
 
 Note To Employment Agencies
 
 
 
 We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.
 
 
 Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.
 
 
 The national salary range for Claims Specialist II - Management Specialty Lines : $69,500.00-$129,000.00
 
 
 The expected starting salary range for Claims Specialist II - Management Specialty Lines : $69,500.00 - $103,500.00
</div>

Claims Specialist II - Management Specialty Lines

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