medical claims specialist

eVolve Health

Evolve Health Medical Claims SpecialistJoin the Evolve Health team as a Medical Claims Specialist at our Portland, Oregon administrative offices. Evolve Health provides medication management, interventional psychiatric treatments such as intranasal Spravato&trade; for treatment-resistant depression, transcranial magnetic stimulation (TMS), as well as ketamine infusions for depression, anxiety, and PTSD.We are looking for a positive, motivated individual to support our patients and our team. This position requires strong communication skills, critical thinking, attention to detail and compassion for people with mental health struggles.To ensure success, you should be professional with good interpersonal skills. The ability to complete duties in an environment that requires multi-tasking is essential.We are looking for an individual with well-rounded medical billing experience in some of the following areas:<ul><li>Monitoring A/R aging reports.</li><li>Monitoring insurance company policy updates.</li><li>Addressing denied or underpaid claims.</li><li>Preparing/submitting insurance appeals.</li><li>Posting patient and insurance payments.</li><li>Charge entry and submission of clean claims.</li><li>Using insurance portals.</li><li>Benefits and Eligibility verification.</li><li>Prior Authorizations.</li><li>Reviewing patient accounts for accuracy and completeness.</li><li>Answering patient and insurance telephone inquiries.</li><li>In addition to these general duties, we may request that you perform other duties that fit with your training and background experience or provide further training for new duties.</li></ul>SKILLS AND APTITUDES<ul><li>Must work well in a team environment</li><li>Positive attitude</li><li>Customer-service minded</li><li>Detail oriented and willing to learn</li><li>Good follow-through and perseverance</li><li>Self-motivated with the ability to work independently</li><li>Able to work in environment with direct communication</li><li>Understanding of HIPAA regulations</li><li>Proficient with Microsoft Word, Excel and Teams</li><li>Previous experience with Advanced MD preferred</li></ul>Please note this is not a remote position.Job Type: Full-timePay: $25.00 - $29.00 per hourExpected hours: No more than 40 per weekBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>Medical/Psych Billing: 2 years (Preferred)</li></ul>Ability to Commute:<ul><li>Portland, OR 97222 (Required)</li></ul>Work Location: In person

Medical Claims Specialist

HealthSource of Ohio

<div>
 
 
 Centerprise Inc. is seeking to hire a Medical Claims Specialist to join our team.
 
 
 
 
 
 &nbsp;
 
 
 
 
 
 &nbsp;
 
 
 
 
 
 JOB SUMMARY:
 
 &nbsp;
 
 
 
 The Medical Claims Specialist performs a variety of billing and administrative tasks including claim submission, claim correction, insurance follow-up and appeals and insurance verification. They will also assist with all other billing and finance duties as needed.&nbsp;
 
 
 
 &nbsp;
 
 
 
 
 ABOUT THE COMPANY:
 
 
 
 
 Centerprise is a professional services organization providing consulting and Revenue Cycle Management services to Federally Qualified Health Centers (FQHCs). We are located outside Cincinnati, Ohio, and conduct business nationally.
 
 
 
 &nbsp;
 
 
 
 Centerprise is a company on the rise! &nbsp;We are very excited to say that we currently employ 25 staff members, and we are steadily growing! &nbsp;We take great pride in focusing on employee satisfaction. &nbsp;Happy employees; means happy customers!&nbsp;
 
 
 
 &nbsp;
 
 
 
 At Centerprise we offer our clients a wide variety of services, therefore, we require a large range of skill sets within our company. We would love to hear from dynamic individuals who are seeking an opportunity to grow their skills in an upbeat, fast paced, and team-based environment.
 
 
 
 &nbsp;
 
 
 
 Centerprise has a small company feel, with larger company resources. Please refer to our website for more information,&nbsp;www.ctprcm.com.
 
 
 
 
 &nbsp;
 
 
 
 
 
 ESSENTIAL DUTIES AND RESPONSIBILITIES:
 
 &nbsp; &nbsp;
 
 
 <ul>
 
 <li>
 
 Follow-up:
 
 &nbsp;Regularly monitor patient account insurance balances to ensure timely payment and resolve any outstanding issues.
 </li>
 
 <li>
 
 Payer Communication:
 
 &nbsp;Contact payers regarding payment status, resolve incorrect payment issues, and ensure proper reimbursement.
 </li>
 
 <li>
 
 Denial Management:
 
 &nbsp;Work closely with leadership to address and resolve any denied claims promptly.
 </li>
 
 <li>
 
 Understanding Guidelines:
 
 &nbsp;Stay informed about both government and non-government contractual billing and follow-up guidelines, ensuring compliance with individual payer requirements.
 </li>
 
 <li>
 
 Payment Resolution:
 
 &nbsp;Address issues related to lack of payment or improper payment by government, non-government, and self-payers, ensuring that all incorrect payment issues are resolved promptly.
 </li>
 
 </ul>
 
 
 
 &nbsp;
 
 
 
 
 
 QUALIFICATIONS:
 
 To perform this job successfully, an individual must be able to perform each essential duty completely. The requirements listed below are representative of the knowledge skill and/or ability required.
 
 
 
 
 Minimum Qualifications:
 
 
 
 <ul>
 
 <li>
 High School Diploma or Equivalent (GED), associate degree preferred.
 </li>
 
 <li>
 Medical billing experience required. FQHC billing experience is a plus.
 </li>
 
 <li>
 Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets.
 </li>
 
 <li>
 Knowledge of Medical Terminology, CPT and ICD-10 Coding, Electronic Billing, and HIPPA
 </li>
 
 <li>
 EHR Experience is required. Preferred experience with NextGen.
 </li>
 
 <li>
 Excellent written and oral communication skills
 </li>
 
 </ul>
 
 
 &nbsp;
 
 
 
 
 Pay:
 
 &nbsp;$18-$22/hour based on experience
 
 
 
 &nbsp;
 
 
 
 
 Benefits:&nbsp;
 
 
 
 <ul>
 
 <li>
 Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts
 </li>
 
 <li>
 401 (k) Program with competitive company match
 </li>
 
 <li>
 Courtesy Care (full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio Practice)
 </li>
 
 <li>
 PTO, full time employees earn up to 20 days per year in first calendar year: 20 days of Paid Time Off (PTO)
 </li>
 
 <li>
 Credit Union Privileges, Sharefax Credit Union
 </li>
 
 <li>
 Quarterly Bonus Incentive Program available after 90 day probation period.&nbsp;
 </li>
 
 </ul>
 
 
 &nbsp;
 
 
 
 
 Schedule:&nbsp;
 
 
 
 <ul>
 
 <li>
 Monday to Friday; no evenings, or weekends
 </li>
 
 </ul>
 
 
 &nbsp;
 
 
 
 
 Work Location:
 
 Loveland, OH 45140. Must be able to commute or planning to relocate before starting work.
 
 
 
 &nbsp;
 
 
 
 &nbsp;
 
 
 
 Centerprise Inc. is an Equal Opportunity/Affirmative Action Employer:
 
 
 
 Minority/Female/Disabled/Veteran
 
 
 
 &nbsp;
 
 
 
 
 
 
 
 &nbsp;
 
 
 
 
 
 
 
 &nbsp; &nbsp;
 
</div>

Amerit Consulting

<div>
 
 
 
 OVERVIEW:
 
 
 
 
 
 Our client, a US Fortune 50 organization and a leading provider of Healthcare and Health Insurance services
 
 , seeks an accomplished
 
 Medical Claims Specialist
 
 .
 
 
 
 
 
 
 
 IMPORTANT NOTES: REMOTE / WORK-FROM-HOME RELATED:
 
 
 
 <ul>
 <li>
 
 This will be a Remote role.
 
 </li>
 <li>
 
 Equipment's will be provided.
 
 </li>
 <li>
 MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections are not allowed.
 </li>
 <li>
 MUST have a reliable home-office environment.
 </li>
 <li>
 
 Payrate would be $18.15 per hour. The worker must also receive an additional $5.55 per hour payment in lieu of benefits. Total hourly Pay rate would be $23.70 per hour.
 
 </li>
 <li>
 
 Training Shift Hours: 40 hours per week | 08:00am to 4:30pm (Eastern Time).
 
 </li>
 <li>
 
 Training will be 5-6 weeks.
 
 </li>
 <li>
 
 After training, the candidates may choose to flex start time of 6:00 AM to 10:00 AM (Eastern Time).
 
 </li>
 </ul>
 
 
 
 
 
 
 Client will be considering candidates MUST sit within 50 miles of below location (Please apply accordingly):
 
 
 
 <ul>
 <li>
 Dennison, TX
 </li>
 <li>
 Atlanta, GA
 </li>
 <li>
 Midland/Columbus, GA
 </li>
 <li>
 Indianapolis, INDIANA
 </li>
 <li>
 Louisville, KY
 </li>
 <li>
 Gilbert, MN
 </li>
 <li>
 St Louis, MO
 </li>
 <li>
 Winston-Salem, NC
 </li>
 <li>
 Cincinnati, OH
 </li>
 <li>
 Columbus, OH
 </li>
 <li>
 Mason, OH
 </li>
 <li>
 Nashville, TN
 </li>
 <li>
 Norfolk, VA
 </li>
 <li>
 Richmond, VA
 </li>
 <li>
 Roanoke, VA
 </li>
 <li>
 Baltimore, MD
 </li>
 </ul>
 
 
 
 
 
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 This is an entry level position in the NGS Appeals Department that reviews, analyzes and
 
 processes non-complex pre-service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A &amp; B)
 
 related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
 </li>
 <li>
 Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
 </li>
 <li>
 Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
 </li>
 <li>
 The grievance and appeal work are subject to applicable accreditation and regulatory standards and requirements.
 </li>
 <li>
 As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
 </li>
 <li>
 Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
 </li>
 <li>
 Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
 </li>
 <li>
 The analyst may serve as a liaison between grievances &amp; appeals and /or medical management, legal, and/or service operations and other internal departments.
 </li>
 </ul>
 
 
 
 
 
 
 Required Qualifications:
 
 
 
 <ul>
 <li>
 
 Must have High School Diploma or GED.
 
 </li>
 <li>
 
 Must have 3-4 years&rsquo; experience working with Medical Claims, grievances and appeals, Medicare, Part A OR PART B.
 
 </li>
 <li>
 
 Familiarity with medical terminology, demonstrated business writing proficiency.
 
 </li>
 <li>
 Must have strong understanding of provider networks, the
 
 medical management process
 
 ,
 
 claims processing
 
 .
 </li>
 <li>
 Must be proficient handling
 
 high volume
 
 
 inbound calls
 
 .
 </li>
 <li>
 Must have background in
 
 following up with insurance providers
 
 .
 </li>
 </ul>
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 
 
 
 
 Recruiter Contact Info
 
 
 
 Jatin Rattan
 
 
 E-mail: jatin.rattan@ameritconsulting.com
 
 
 www.ameritconsulting.com
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 Company Overview:
 
 
 
 Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local &amp; regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients&rsquo; businesses forward.
 
 
 
 
 
 Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
 
 
 
 
 
 This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.
 
</div>

CNS Cares

<div>Description:

Pay Rate: $18.00 - $22.00 per hour depending on experience, plus lucrative bonus potential 
Location: Albuquerque, NM 
Full-Time, In-Office, Monday - Friday
Benefits Summary:<ul><li>
Medical, dental, vision, and 401K</li><li>
Health Savings Account (HSA)</li><li>
Matching 401k</li><li>
Paid Time Off (PTO)</li></ul>
SUMMARY
On behalf of CNS Cares, LLC (&ldquo;CNS&rdquo; or &ldquo;Company&rdquo;), this position is responsible for developing relationships with leads and claimants, associated retiree groups, physicians, authorized representatives, agency personnel, and other various stakeholders associated with the EEOICPA program and other programs as required. 
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Employee must have regular attendance/punctuality, have excellent customer service skills, be able to work with others at all levels of the Company and be completely honest. This position will be in office, without remote capability. Other assigned duties include:<ul><li>
Provide assistance to claimants as needed, by guiding claimants through the claim filing process, and supporting in other ways as needed.</li><li>
Determine what benefits these individuals may qualify for under the EEOICPA or other identified programs.</li><li>
Assist in research and gather work history and medical records as necessary.</li><li>
Help claimants file initial claims and refile claims that have been denied.</li><li>
Inform individuals of the resources available that may assist their claim process and overall health and wellness.</li><li>
Answering &amp; returning frequent phone calls/emails in a polite &amp; timely manner with internal and external customers.</li><li>
Maintains industry knowledge by participating in educational and training opportunities.</li><li>
Assists in identifying efficiencies and improving processes.</li><li>
Maintains contact with professionals of various health service agencies, after obtaining a Release of Information, to determine Claimant eligibility services.</li><li>
Occasionally will attend outreach events as needed.</li><li>
Other duties as assigned.</li></ul>
Requirements:

EDUCATION and/or EXPERIENCE 
Required:<ul><li>
High school Diploma or GED.</li><li>
At least two (2) years of related program or clinical/medical experience and/or training.
</li></ul>Preferred:<ul><li>
Certified Medical Assistant (CMA) certification or Licensed Practical Nurse (LPN) preferred, but not required</li><li>
At least one (1) year of specific DOL EEOICPA program experience.</li></ul>
RELATED COMPETENCIES
Knowledge of DOL EEOICPA program, knowledge of the EEOICPA application process, specifically the records necessary for any potential claimant to file a claim under the EEOICPA. Knowledge of medical terminology and the ability to translate terminology into verbal and written communication. 
Licensure/Certification<ul><li>
Valid Driver&rsquo;s License</li></ul>
Clearances
The following background checks are conducted:<ul><li>
Criminal background</li><li>
Driving Record</li><li>
OIG Exclusion List</li><li>
Sex Offender Registry</li></ul>
#TFIND</div>

<div>Description:

Pay Rate: $18.00 - $22.00 per hour depending on experience, plus lucrative bonus potential 
Location: Grants, NM 
Full-Time, In-Office, Monday - Friday
Benefits Summary:<ul><li>
Medical, dental, vision, and 401K</li><li>
Health Savings Account (HSA)</li><li>
Matching 401k</li><li>
Paid Time Off (PTO)</li></ul>
SUMMARY
On behalf of CNS Cares, LLC (&ldquo;CNS&rdquo; or &ldquo;Company&rdquo;), this position is responsible for developing relationships with leads and claimants, associated retiree groups, physicians, authorized representatives, agency personnel, and other various stakeholders associated with the EEOICPA program and other programs as required. 
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Employee must have regular attendance/punctuality, have excellent customer service skills, be able to work with others at all levels of the Company and be completely honest. This position will be in office, without remote capability. Other assigned duties include:<ul><li>
Provide assistance to claimants as needed, by guiding claimants through the claim filing process, and supporting in other ways as needed.</li><li>
Determine what benefits these individuals may qualify for under the EEOICPA or other identified programs.</li><li>
Assist in research and gather work history and medical records as necessary.</li><li>
Help claimants file initial claims and refile claims that have been denied.</li><li>
Inform individuals of the resources available that may assist their claim process and overall health and wellness.</li><li>
Answering &amp; returning frequent phone calls/emails in a polite &amp; timely manner with internal and external customers.</li><li>
Maintains industry knowledge by participating in educational and training opportunities.</li><li>
Assists in identifying efficiencies and improving processes.</li><li>
Maintains contact with professionals of various health service agencies, after obtaining a Release of Information, to determine Claimant eligibility services.</li><li>
Occasionally will attend outreach events as needed.</li><li>
Other duties as assigned.</li></ul>
Requirements:

EDUCATION and/or EXPERIENCE 
Required:<ul><li>
High school Diploma or GED.</li><li>
At least two (2) years of related program or clinical/medical experience and/or training.</li></ul>
Preferred:<ul><li>
Certified Medical Assistant (CMA) certification or Licensed Practical Nurse (LPN) preferred, but not required</li><li>
At least one (1) year of specific DOL EEOICPA program experience.</li></ul>
RELATED COMPETENCIES
Knowledge of DOL EEOICPA program, knowledge of the EEOICPA application process, specifically the records necessary for any potential claimant to file a claim under the EEOICPA. Knowledge of medical terminology and the ability to translate terminology into verbal and written communication. 
Licensure/Certification<ul><li>
Valid Driver&rsquo;s License</li></ul>
Clearances
The following background checks are conducted:<ul><li>
Criminal background</li><li>
Driving Record</li><li>
OIG Exclusion List</li><li>
Sex Offender Registry</li></ul>
#TFIND</div>

Metro Vein Centers

<div><div>Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. Our board-certified physicians and expert staff are on a mission to improve people's quality of life by relieving the painful, yet highly treatable symptoms of vein disease&mdash;such as varicose veins and heavy, aching legs.

With over 60 clinics across 7 states, and still growing, we're building the future of vein care&mdash;delivering compassionate, results-driven care in a modern, patient-first environment.

We proudly maintain a Net Promoter Score (NPS) of 93, the highest patient satisfaction in the industry.</div>
We're seeking a detail-oriented, results-driven Claims Resolution Specialist to support our billing and revenue cycle operations. In this role, you'll manage assigned claims, follow up on denials, ensure accurate and timely payment, and support the financial health of our clinics through effective payer engagement.

This is a hybrid position based in West Bloomfield, MI.

What You'll Do
<ul>
<li>Investigate and resolve claim denials and underpayments from insurance providers</li>
<li>Research payer-specific policies and submit accurate, timely appeals</li>
<li>Follow up on unpaid or delayed claims using payer portals and internal billing systems</li>
<li>Monitor aging reports and prioritize claims follow-up based on timely filing and payer deadlines</li>
<li>Perform insurance re-verification as needed and reprocess claims to appropriate payers</li>
<li>Accurately post payments and adjustments, including co-payments, deductibles, and coinsurance</li>
<li>Support billing operations, including charge entry, rejection resolution, and documentation reviews</li>
<li>Collaborate with internal teams to escalate payer issues and reduce future denials</li>
<li>Maintain meticulous records of follow-ups, appeal status, and payment resolutions in the EMR</li>
</ul><h3 class="jobSectionHeader">What You'll Bring</h3>
<ul><li>2+ years of experience in medical billing, claims resolution, or insurance follow-up</li>
<li>Solid understanding of insurance guidelines, claim cycles, and payer behavior</li>
<li>Proficiency with CPT, ICD-10, and medical billing workflows</li>
<li>Comfortable using payer portals, EMR systems, and Excel/Google Sheets</li>
<li>Organized, self-motivated, and accountable with strong time management skills</li>
<li>Clear written and verbal communication when working with both payers and internal teams</li>
<li>High school diploma or equivalent required</li>
</ul><h3 class="jobSectionHeader">Preferred Skills</h3>
<ul><li>Familiarity with Centricity EMR</li>
<li>Previous experience in surgical or specialty practice billing</li>
<li>Knowledge of revenue cycle metrics and KPIs</li>
</ul><h3 class="jobSectionHeader">Benefits to Support Your Wellbeing &amp; Lifestyle</h3>

Full-time team members at Metro Vein Centers are eligible for:
<ul>
<li>Medical, Dental, and Vision Insurance</li>
<li>401(k) with Company Match</li>
<li>Paid Time Off (PTO) + Paid Company Holidays</li>
<li>Company-Paid Life Insurance</li>
<li>Short-Term Disability Insurance</li>
<li>Employee Assistance Program (EAP)</li>
<li>Career Growth &amp; Development Opportunities</li>
</ul>
Schedule
<ul>
<li>Monday - Friday</li>
<li>This is a hybrid position based in West Bloomfield, MI.</li>
<li>Monday-Friday: 8:30am-5:00pm</li>
</ul>
#LI-hybrid<div>
The Metro Vein Centers Difference

Healthy legs. Happier lives. 
At Metro Vein Centers, we believe exceptional care begins with an exceptional experience. Our mission is to make vein care approachable, empowering, and connected to overall well-being. From the first conversation to the final follow-up, every patient interaction reflects our commitment to compassion, expertise, and trust.

A team united by purpose. 
Our values guide everything we do:
<ul>
<li>Patients First, Always &ndash; Every interaction should make our patients feel valued, heard, and cared for.</li>
<li>Stronger Together &ndash; Teamwork and collaboration drive our success. We lift each other up to deliver the best for our patients.</li>
<li>A Can-Do Spirit &ndash; We meet every challenge with positivity, flexibility, and problem-solving energy.</li>
<li>Results That Make a Difference &ndash; We're driven to improve lives through meaningful, measurable outcomes.</li>
<li>Commitment to Growth &ndash; We invest in our people, fostering advancement and professional development at every level.</li>
</ul>
Metro Vein Centers is an Equal Opportunity Employer. 
We're committed to creating a workplace where everyone feels seen, heard, and supported. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetics, gender identity or expression, sexual orientation, veteran status, or any other protected status in accordance with applicable federal, state, and local laws. This policy applies to all aspects of employment, including recruitment, hiring, promotion, compensation, benefits, and termination.

Legal &amp; Compliance Notice: 
Metro Vein Centers complies with all applicable federal, state, and local employment laws, including those related to nondiscrimination, equal opportunity, and pay transparency. Where specific disclosures or postings are required by law, we provide this information as part of our hiring process or upon request.

Your privacy matters. 
To learn more about how we collect, use, and protect your information, please review our privacy policy here.</div></div>

Medical Claims Resolution Specialist

CorVel Corporation

<div>The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers&rsquo; compensation claims under close supervision, supporting the goals of the Claims Department and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives claims, confirms policy coverage and acknowledgement of the claim</li>
<li>Determines the validity and compensability of the claim</li>
<li>Establishes reserves and authorizes payments within established reserving authority limits</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Assists other claims professionals with more complex or problematic claims as necessary</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Excellent customer service skills</li>
<li>Excellent written and verbal communication skills</li>
<li>Fast learner; develops knowledge and understanding of claims practice, relevant statutes, and medical terminology</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Ability to work both independently and within a team environment</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 1 year industry experience and claim handling</li>
<li>WC experience required</li>
<li>Licensed as required jurisdictionally</li></ul> 


PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $16.74 - $26.92 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Remote</div>

WC Medical Only Claims Specialist

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

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