medical claims specialist

IGarner System

Job Title: Medical Billing SpecialistJob Description: We are looking for a Medical Billing Specialist with strong expertise in PIP, Workers&rsquo; Compensation, and No-Fault AR processes. The ideal candidate must be fluent in English and capable of handling end-to-end billing tasks efficiently, ensuring accuracy and timely claim submission.Key Responsibilities:<ul><li>Manage and process medical claims related to PIP, Workers&rsquo; Compensation, and No-Fault AR.</li><li>Review and verify patient information, insurance details, and claim accuracy.</li><li>Follow up on unpaid claims and handle denials or rejections promptly.</li><li>Communicate effectively with insurance companies, providers, and patients to resolve billing issues.</li><li>Maintain up-to-date knowledge of medical billing regulations and payer policies.</li><li>Prepare regular reports on account receivables and billing status.</li></ul>Requirements:<ul><li>Proven experience in Medical Billing with focus on PIP, Workers&rsquo; Compensation, and No-Fault AR.</li><li>Strong understanding of medical billing terminology and insurance procedures.</li><li>Excellent communication skills &mdash; fluency in English (verbal and written) is a must.</li><li>Attention to detail, accuracy, and time management skills.</li><li>Proficiency in billing software and MS Office tools.</li></ul>Working Hours: 6:00 PM &ndash; 3:00 AM (Night Shift)Job Type: Full-timePay: Rs50,000.00 - Rs80,000.00 per monthWork Location: In person

ARE/Medical Billing Specialist

CES, LLC

<div>Job Description Summary: 
The Claims Analyst ensures the review and analysis of sampled Medicaid claims using associated medical records; makes payment determinations based on coverage, coding, utilization of services and practice guidelines; and makes medical necessity determinations utilizing clinical review judgment in accordance with the PERM Program policies and contract responsibilities. The period of performance for this role is from 12/1/2025-3/15/2026. 
 
Duties/Responsibilities: 
<ul><li>Conducts in-depth claims analysis utilizing ICD-9-CM, ICD-10-CM, CPT-4, APR-DRG, and HCPCS Level II coding principles</li>
<li>Conducts medical record audits to determine the medical necessity and/or appropriateness of medical treatment as defined by the Statement of Work and CMS directives as well as State specific regulations pertaining to Medical necessity</li>
<li>Reviews the Master Policy List and the MR questionnaire and develops State Fact Sheets and Resource Page for each assigned State prior to the review of claims for that State</li>
<li>Functions as the policy and regulation expert in assigned states</li>
<li>Provides electronic documentation of findings and conclusions with determinations of claims payment appropriateness in review tool fields</li>
<li>Reviews and completes the required number of claims reviews in accordance to established production standards for the project</li>
<li>Communicates internally with all levels of PERM staff</li>
<li>Attend assigned State meetings</li>
<li>Participates in QA and IRR monitoring as requested</li>
<li>Complies with departmental policies and procedures</li>
<li>Comply with QA benchmarks established by the PERM MR department</li>
<li>Attends departmental and required education and training programs</li>
<li>Performs other projects or duties as assigned by the Senior Medical Review Specialist</li>
</ul>
 
Required qualifications/skills: 
<ul><li>Graduate from an accredited Registered Nurse (RN) school (associate degree or diploma based) or Bachelor's Degree (preferred) with active state licensure in one or more of the 50 states or D.C.</li>
<li>Ability to comprehend medical policy and criteria to clearly articulate health information</li>
<li>Team-oriented and able to implement the operational strategies and procedures that will help achieve the overall quality and production goals of the Medical Review unit</li>
<li>Knowledge of ICD-10-CM and CPT-4 coding</li>
<li>Minimum three years of experience in a clinical setting with experience evaluating medical necessity of services, diagnosis and procedure coding and appropriateness of clinical settings.</li>
<li>Inpatient Interqual/Milliman screening or similar product experience preferred</li></ul></div>

Medical Claims Analyst (RN)

Macrise Tech Solutions

Job Title: Medical Billing &amp; Collections Specialist Location: Wapda Town, Lahore (if you want to include location)We are seeking a highly organized and detail-driven Medical Billing &amp; Collections Specialist to join our healthcare revenue cycle team. The ideal candidate will be responsible for accurately preparing insurance claims, managing patient billing, and ensuring timely payment collection. This role requires strong analytical skills, attention to detail, and effective communication with patients, insurance payers, and internal teams to support smooth billing operations and maintain strong cash flow.Key ResponsibilitiesMedical Billing<ul><li>Prepare and submit timely and accurate insurance claims and patient invoices.</li><li>Review all claims for accuracy, correct coding, and compliance with payer and regulatory guidelines.</li><li>Maintain organized and up-to-date billing records within the practice management system.</li><li>Process adjustments, credit memos, and payments accurately.</li><li>Verify and update patient demographics and insurance details regularly.</li><li>Generate monthly billing statements and custom Revenue Cycle Management (RCM) reports.</li><li>Assist the accounting team with reconciliations and month-end reporting.</li><li>Identify and recommend improvements to enhance billing accuracy and workflow efficiency.</li></ul>Collections<ul><li>Follow up proactively on outstanding insurance claims and patient balances to secure timely payments.</li><li>Manage and monitor Accounts Receivable (A/R) aging reports with focus on overdue accounts.</li><li>Coordinate with insurance providers to resolve delays, underpayments, and denials.</li><li>Handle patient billing inquiries professionally and set up payment arrangements when appropriate.</li><li>Work with patient services and billing teams to address complex collection cases.</li><li>Document all collection activities, communication, and follow-ups accurately in the system.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Claims & Collections Specialist – Medical Billing

We are seeking a highly organized and proactive Insurance Verification &amp; Authorization Specialist to join our medical billing team. This position is responsible for verifying patient insurance coverage, securing prior authorizations, and maintaining accurate records to support smooth billing and claims processing. The ideal candidate will have strong communication skills, attention to detail, and a solid understanding of payer guidelines, with the ability to perform efficiently in a fast-paced healthcare setting.Key ResponsibilitiesInsurance Verification &amp; Eligibility<ul><li>Verify patient insurance benefits through payer portals and direct communication with insurance representatives.</li><li>Accurately update and maintain eligibility details within the Electronic Health Record (EHR) system (e.g., eClinicalWorks).</li><li>Complete and upload insurance verification documentation promptly for new patients.</li><li>Clearly communicate estimated out-of-pocket costs to patients.</li><li>Escalate unresolved coverage or financial concerns to the Patient Collections team.</li><li>Follow up with patients to obtain missing or updated insurance information in a timely manner.</li></ul>Authorizations &amp; Compliance<ul><li>Obtain prior authorizations for services that require insurance approval.</li><li>Ensure compliance with Medicaid and other payer-specific authorization rules.</li><li>Coordinate with the Patient Services team to manage out-of-network insurance cases.</li><li>Secure authorizations for psychological evaluations and maintain accurate documentation and system alerts.</li></ul>Operational Support &amp; Coordination<ul><li>Assist with same-day or urgent appointment scheduling when necessary.</li><li>Report payer policy updates, billing discrepancies, and changes in provider network status.</li><li>Work with the Practice Manager to resolve incomplete patient intake files.</li><li>Participate in recurring team meetings to improve processes, ensure data accuracy, and enhance operational efficiency.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Insurance Verification Executive-Medical Billing

<div>The Senior Claims Specialist will be responsible for the preparation, evaluation, and negotiation of contractual claims, variations, and disputes related to the Construction Contracts under the Government Tender and Procurement Law. The role requires a deep understanding of consultancy contracts, construction claims, entitlement analysis, and the legal and procedural frameworks governing government-sector projects in Saudi Arabia.</div>
 <div><ul><li>Review and analyze contractual documents to identify potential claims and entitlements.
</li><li>Prepare detailed claim submissions, including quantum, time impact analysis, and supporting documentation.
</li><li>Advise project management teams on claim strategies and defense mechanisms.
</li><li>Liaise with clients, contractors, and legal advisors to facilitate the resolution of claims and disputes.
</li><li>Review change orders, variation requests, and contract amendments to ensure compliance with contract provisions.
</li><li>Prepare position papers and contractual correspondence in alignment with WSP corporate and client procedures.
</li><li>Monitor key contractual milestones and risk events to ensure timely claim notifications and record-keeping.
</li><li>Maintain accurate claim logs and reporting dashboards in coordination with the commercial team.
</li><li>Support dispute avoidance and early resolution efforts across project stakeholders.
</li><li>Ensure that all claim-related activities comply with Saudi Government contracting regulations and WSP internal governance.</li></ul></div>
 <div><ul><li>Bachelor&rsquo;s Degree in Engineering, Quantity Surveying, Law, or equivalent discipline.
</li><li>Minimum of 12 years of relevant experience, including at least 5 years in claim management for major infrastructure or consultancy contracts.
</li><li>Strong understanding of the Saudi Government Tender and Procurement Law (&#1606;&#1592;&#1575;&#1605; &#1575;&#1604;&#1605;&#1606;&#1575;&#1601;&#1587;&#1575;&#1578; &#1608;&#1575;&#1604;&#1605;&#1588;&#1578;&#1585;&#1610;&#1575;&#1578; &#1575;&#1604;&#1581;&#1603;&#1608;&#1605;&#1610;&#1577;) and its Executive Regulations.
</li><li>Demonstrated ability to lead claim strategy development and negotiation with government clients.
</li><li>Strong communication and report-writing skills in both English and Arabic.
</li><li>Prior experience working with a consultancy firms.
</li><li>Prior experience in government-sector project supervision consultancy contracts in KSA
</li><li>Experience in infrastructure or municipal projects.
</li></ul>Imagine a better future for you and a better future for us all.
Join our close-knit community of talented individuals who share your passion for making a positive impact. Our global team includes more than 69,000 employees, working together to make a difference in communities both close to home and around the world.
With us, you can. Apply today.</div>

Senior Claims Specialist

WHEALTH INTERNATIONAL L.L.C

<ul><li>Analyze medical claims for accuracy, ensuring all details align with provided documentation and coding guidelines.</li><li>Investigate and resolve claim discrepancies, contacting providers and patients to gather necessary information and clarify issues.</li><li>Process claims efficiently using specialized software, meeting daily processing targets and maintaining a high level of accuracy.</li><li>Verify patient eligibility for benefits, confirming coverage details and communicating any limitations to relevant parties.</li></ul>

Medical Claims Processor

Allianz

SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends cal SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends calls and e-mails from insurance companies, clients, and providers.   Coordinates with international providers for direct billing.   Makes suggestions to improve service.   Increases efficiency, minimizes errors and administration time. BEHAVIORAL REQUIREMENTS   Organizational &amp; time management skills.   Excellent team player.   Ability to work well with all levels of internal management and staff, as well as outside clients and users.   Ability to demonstrate sound work ethics.   Show flexibility with excellent interpersonal skills.   The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.   To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.   The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.   Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others. BEHAVIORAL COMPETENCY Customer &amp; Market Excellence:   Strive for excellence at every touch point with the customer   Foster state-of-art technical/operational knowledge and strive for continuous simplification   Be the benchmark Collaborative Leadership:   Empower the team and provide purpose and direction   Develop people, provide feedback and care to employee wellbeing   Collaborate and exchange best practice. Entrepreneurship:   Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure   Take ownership and responsibility   Embrace innovation and a culture that allows to make decisions without fear of retribution. Trust:   Act with integrity, honor commitments, tell the truth   Foster diversity and inclusiveness   Act transparently and promote corporate social responsibility. MINIMUM REQUIREMENTS   Bachelor's of Medicine (MBBS) only.   Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).   Physically fit to carry out duties.   Legally permitted to work in the country of operations.   Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills 44265 | Operations | Professional | ((custPositionClusterCSB)) | Allianz Partners | Full-Time | Permanent Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Great to have you on board. Let's care for tomorrow.

Medical Claims Officer

Search 10000+ Medical claims specialist jobs near you this November. New roles added regularly across leading industries. Apply today.