medical insurance claims specialist

Medical Foot Care Center

Established physician office seeking an experienced Medical Claims Follow-Up Specialist to manage insurance accounts receivable, denials, and appeals. This role is ideal for someone who enjoys problem-solving, working accounts, and ensuring accurate reimbursement from commercial and government payers.Small, team-oriented office with a supportive work environment and long-term stability.Key Responsibilities<ul><li>Review and follow up on insurance denials and unpaid claims</li><li>Submit corrected claims and appeals as needed</li><li>Work with payers including UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield</li><li>Analyze EOBs and ensure accurate payment posting and adjustments</li><li>Identify trends in denials and recommend solutions</li><li>Correct errors related to demographics, coding, and charge entry</li><li>Communicate with insurance companies regarding claim status</li><li>Assist front office with patient account questions as needed</li></ul>Qualifications<ul><li>Minimum 1&ndash;2 years experience in medical claims follow-up / AR</li><li>Strong understanding of insurance guidelines and billing processes</li><li>Experience with denials, appeals, and payment posting</li><li>Familiarity with CMS and commercial payer rules</li><li>Strong analytical and organizational skills</li><li>Ability to manage multiple accounts in a fast-paced environment</li></ul>Additional Requirements<ul><li>Proficient in Microsoft Word, Excel, and practice management systems</li><li>High school diploma or equivalent required</li><li>Ability to sit/stand and work at a computer for extended periods</li></ul>Compensation &amp; Schedule<ul><li>Full-time, Monday&ndash;Friday (9 AM &ndash; 5 PM)</li><li>Compensation: Based on experience</li></ul>Additional Information<ul><li>This is an in-office position</li><li>Benefits: Not offered at this time</li></ul>Job Type: Full-timeExperience:<ul><li>Insurance specialist: 1 year (Required)</li><li>Claim Follow Up: 1 year (Required)</li></ul>Work Location: In personPay: $18.00 - $23.00 per hourBenefits:<ul><li>Paid time off</li></ul>Work Location: In person

Medical Claims Follow up Specialist

The Woman's Health Pavilion

The Woman's Health Pavilion is a growing OB/GYN practice, established in 1971. We are seeking a detail-oriented and knowledgeable Medical Claims Specialist to join our healthcare team. The ideal candidate will be responsible for managing and processing medical claims efficiently, ensuring accurate coding, billing, and reimbursement. This role is vital in maintaining the financial health of our healthcare operations and providing excellent service to our patients and providers. Prior experience with medical billing, coding, and electronic health record systems is highly valued. The position offers an opportunity to work in a professional environment dedicated to accuracy, compliance, and patient care excellence.Duties<ul><li>Review and process medical claims using EMR and EHR systems to ensure timely submission and reimbursement</li><li>Apply appropriate medical coding including ICD-10 and ICD coding standards for accurate claim generation</li><li>Verify insurance coverage and patient eligibility prior to claim submission</li><li>Resolve claim denials or rejections by analyzing errors related to medical records or coding inaccuracies</li><li>Collaborate with healthcare providers to clarify documentation discrepancies</li><li>Maintain detailed records of claims processed and follow up on outstanding payments or collections</li><li>Ensure compliance with healthcare regulations and insurance policies during all claim handling activities</li><li>Assist in updating and maintaining accurate medical records related to billing and claims processing</li></ul>Skills<ul><li>Proficiency in medical billing, coding (ICD-10), and medical records management</li><li>Strong understanding of medical terminology and healthcare documentation standards</li><li>Experience working with EMR/EHR systems for claims processing and record management</li><li>Knowledge of insurance policies, medical collections, and reimbursement procedures</li><li>Ability to interpret complex medical data and accurately assign appropriate codes</li><li>Excellent organizational skills with attention to detail to minimize errors in claims processing</li><li>Effective communication skills for collaborating with healthcare providers, insurance companies, and patients</li><li>Prior experience in a medical office setting is preferred but not required; training will be provided as needed</li></ul>Qualifications<ul><li>High School Diploma/GED</li><li>Experience a plus but not required</li><li>Good verbal and written communication skills.</li><li>Basic understanding of medical ICD 9/ 10 codes and CPT medical billing codes.</li><li>Good telephone and patient relation skills.</li><li>Detail oriented and ability to prioritize work.</li><li>OB/GYN experience a plus</li></ul>This position offers a rewarding opportunity for professionals passionate about healthcare administration, coding accuracy, and efficient claims management.** This position is in-office only and does not offer remote work. **Pay: $20.00 - $25.00 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Medical Claims Specialist

JJ Pediatrics

Overview Join our dynamic healthcare team as a Medical Billing Specialist, where your expertise will drive the financial health of our practice. In this vital role, you will manage the end-to-end billing process, ensuring accurate coding, timely claims submission, and effective collections. Your attention to detail and knowledge of medical coding and billing procedures will directly impact our ability to provide exceptional patient care while maintaining operational efficiency. This position offers an engaging environment for motivated professionals eager to apply their skills in a fast-paced, rewarding setting.Responsibilities<ul><li>Review and assign appropriate DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology), ICD-9, and ICD-10 codes to medical records for accurate billing and reimbursement.</li><li>Prepare and submit claims using Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, ensuring compliance with insurance requirements.</li><li>Follow up on unpaid or denied claims through effective medical collection strategies, including resubmissions and appeals.</li><li>Verify patient insurance coverage, benefits, and eligibility prior to service delivery to streamline billing processes.</li><li>Maintain comprehensive medical records, ensuring all documentation aligns with medical terminology standards and coding guidelines.</li><li>Collaborate with healthcare providers to clarify diagnoses or procedures as needed for precise coding.</li><li>Stay current with updates in medical coding regulations, including changes in ICD coding standards and reimbursement policies.</li></ul>Qualifications<ul><li>Proven experience in medical billing with a strong understanding of medical office operations.</li><li>Familiarity with DRG, CPT coding, ICD-9, ICD-10, and medical terminology essential for accurate claim processing.</li><li>Experience working with E-clinical and EHR systems for documentation and billing purposes.</li><li>Knowledge of medical records management and compliance standards related to medical billing practices.</li><li>Strong attention to detail with excellent organizational skills to handle multiple claims efficiently.</li><li>Ability to interpret complex insurance policies and navigate various payer requirements effectively.</li><li>1+ years prior experience in medical collection processes is highly desirable. Join us in making a difference by ensuring smooth financial operations that support quality healthcare delivery!</li></ul>Pay: $24.03 - $28.94 per hourExpected hours: 40.0 per weekBenefits:<ul><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Queen Creek, AZ 85142

Medical Billing Specialist (CPT, ICD‑10, Insurance Claims)

Manpower

Our client is seeking an experienced Pharmacy Claims &amp; Benefits Specialist to support members, providers, and insurance carriers by verifying eligibility, resolving prescription issues, and ensuring accurate claims processing in a fast-paced pharmacy environment.Schedule<ul><li>Monday &ndash; Friday | 11:30 AM &ndash; 8:00 PM</li><li>Occasional Saturdays &amp; required overtime</li><li>Remote role with potential 1&ndash;2 days onsite in Plymouth, MI</li></ul>Key Responsibilities<ul><li>Verify insurance eligibility and prescription benefits</li><li>Process prescriptions and support claims adjudication</li><li>Communicate with providers, payers, pharmacies, and members to resolve billing or prescription issues</li><li>Coordinate with PBMs and pharmacists</li><li>Maintain accurate documentation and meet productivity/quality goals</li><li>Escalate complex issues as needed</li></ul>Qualifications<ul><li>High School Diploma required; degree preferred</li><li>Active CPhT or Registered Pharmacy Technician license</li><li>1-2 years of pharmacy experience</li><li>Experience with claims adjudication, Medicaid, secondary billing, or discount cards preferred</li><li>Strong communication, attention to detail, and ability to work in a high-volume environment</li><li>Proficiency in Microsoft Office and pharmacy systems</li></ul>Pay: $20.50 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Referral program</li></ul>Work Location: Hybrid remote in Plymouth, MI 48170

Pharmacy Claims & Benefits Specialist

HCA Healthcare

<div>Hourly Wage Estimate: $17.13 - $23.98 / hour 
Learn more about the benefits offered for this job. 
The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
Do you want to join an organization that invests in you as a Medical Insurance Collections Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.<ul><li>This position is Full-time with required on-site orientation/training in our Las Vegas, NV office and the possibility to work from home after meeting and maintaining productivity standards. Experience in ASC or Surgical collections is strongly recommended.</li></ul><h5 class="jobSectionHeader">
Job Summary and Qualifications</h5>
As the Collections Specialist, you will contribute to the company&rsquo;s mission, vision, and values by completing follow-up and collections for patient services. Under the supervision of the Business Office Manager/Business Office Supervisor, you will obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts.
What you will do in this role:<ul><li>
You will perform follow up activities on accounts to ensure prompt payment</li><li>
You will identify coding or billing errors from EOBs and work to correct them</li><li>
You will monitor insurance claims and contact insurance companies to resolve claims</li><li>
You will update the patient account record to identify actions taken</li><li>
You will assign bad debt accounts to the collection agency</li><li>
You will act as a liaison and administer contracts in collection of third party accounts (Medicare and Medicaid)</li><li>
You will complete account reconciliation of accounts turned over to outside agencies</li><li>
You will negotiate payment plans on self-pay accounts</li><li>
You are responsible for maintaining accounts receivable and creating a reduction in bad debt</li></ul>
Qualifications you will need:<ul><li>
Minimum (1) year of collections experience in a medical office setting (i.e. ambulatory surgery center, hospital, doctors office) strongly preferred</li><li>
Knowledge of managed care payers and medical terminology</li></ul>
<h5 class="jobSectionHeader">Benefits</h5>
HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 
 
&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Medical Insurance Collections Specialist opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Medical Insurance Collections Specialist

Bitco Insurance Companies

<div>BITCO Corporation, headquartered in Davenport, IA, is currently seeking a Sr. Claims Specialist to join our regional office located in Atlanta GA. With 11 branch offices in 10 states, BITCO provides quality insurance services to specialized industries including construction, forest products and oil &amp; gas.
This position is eligible for a hybrid work schedule with required business travel to BITCO office locations, customer offices, and other litigation- related travel.

Position Summary:

This position provides key support in the handling of claims across multiple lines of coverage, with a focus on Liability (Commercial Auto, Commercial Property and General Liability). This includes assessing claim coverage, liability, legal and damage issues, and investigating, evaluating, and effectively resolving all assigned claims in a timely manner according to company and regulatory guidelines. Provides a high level of customer service to internal and external business partners.

Primary Responsibilities:
<ul><li>Review, analyze, and interpret policy conditions, exclusions and endorsements to resolve coverage and liability issues for assigned claims</li>
<li>Prepare reservation of rights letters, non-waiver agreements, and coverage disclaimers to address claim coverage issues</li>
<li>Review and evaluate claim reserves to ensure that the respective reserve properly reflects the potential exposure</li>
<li>Investigate claims to evaluate coverage and legal issues, which may include meeting with Insureds and witnesses, and obtaining statements, records, and other evidentiary materials</li>
<li>Provide proper documentation and reporting of investigation and claims handling activities</li>
<li>Negotiates, including through mediation, arbitration, or other court-supervised settlement efforts, settles, and resolves claims with claimants, insureds, and their lawyers; provides appropriate claims resolution documents</li>
<li>Maintain a working knowledge of regulatory and jurisdictional requirements</li>
<li>Provides direction to and management of defense counsel, independent adjusters and other third parties retained to assist in a particular claim</li>
<li>Other duties as assigned</li>
</ul>
Qualifications:
<ul><li>Minimum of 5 years of experience with the following:
<ul><li>Coverage Review &ndash; interpreting policies, agreements and disclaimers</li>
<li>Claims Investigation &ndash; Statements, authorizations, retention of qualified experts and counsel</li>
<li>Claims Administration &ndash; Reports, review reserves, compliance knowledge of laws and procedures</li>
<li>Claims Settlement &ndash; Preparation of disclaimer letters, releases, and proof of loss statements; participation in legal court proceedings when necessary</li>
</ul></li><li>Knowledge of coverage, negligence principles, investigation and negotiation techniques</li>
<li>Ability to obtain and maintain state adjusting licenses, as needed
</li><li>Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service</li>
<li>Ability to communicate clearly and effectively with our customers, claimants, opposing counsel, defense counsel, and members of the public</li>
<li>Ability to manage and organize workload of multiple tasks simultaneously
</li><li>Excellent judgement, negotiation, and decision making skills</li>
<li>Must be able to travel between different off-site locations or overnight in an expeditious manner</li>
<li>Experience in handling liability claims in one or more of the following states: FL, GA, AL, NC, SC, VA, and PA</li>
</ul>
Benefits:
<ul><li>Competitive salary and benefits</li>
<li>Paid time off and 12 paid holidays a year
</li><li>Health, dental, and vision insurance
</li><li>Company paid life insurance &ndash; 2x annual earnings
</li><li>Old Republic 401(k) Savings and Profit Sharing Plan
</li><li>Education and training opportunities
</li><li>Insurance designations encouraged with financial assistance available
</li><li>Daily two-hour flexible start and end time for 7.5-hour workday</li>
<li>Employee Fitness Program</li></ul></div>

Sr. Claims Specialist

Zurich Insurance

<div><div>Zurich is currently looking for a Litigation Claims Specialist to report out of one of the following Zurich North American offices: Any Zurich office location.</div><div></div><div> 
At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected.</div><div></div><div> 
With moderate direction, this position handles multi-party commercial line claims of moderate to high exposure and complexity within specific limits of authority by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.</div><div></div><div> 
Basic Qualifications:</div> 
<div></div><ul><li>
Bachelor&rsquo;s Degree and 3 or more years of experience in the Claims or Insurance area 
OR</li><li>
Zurich Certified Insurance Apprentice, including an associate degree and 3 or more years of experience in Claims or Insurance area 
OR</li><li>
Completion of Zurich Claims Training Program and 3 or more years of experience in the Claims or Insurance area 
OR</li><li>
High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area 
AND</li><li>
Must obtain and maintain required adjuster license(s)</li><li>
Knowledge of insurance regulations, markets and products</li><li>
Microsoft Office experience</li></ul><div></div><div> 
Preferred Qualifications:</div> 
<div></div><ul><li>
3+ years of experience handling Commercial General Liability Litigated Claims</li><li>
Effective verbal and written communication skills</li><li>
Strong analytical, critical thinking, and problem-solving skills</li><li>
Solid time management, prioritization, and multi-tasking skills</li><li>
Experience collaborating in a team environment and building cross functional working relationships.</li><li>
Adept in identifying and explaining complex financial and/or actuarial concepts.</li><li>
Ability to determine the scope and exposure for moderately complex claims.</li><li>
Demonstrates understanding of the reserving process for indemnity and expense in analyzing the potential exposure of moderately complex claims.</li><li>
Ability to develop and execute a negotiation strategy and plan for resolution.</li><li>
Ability to identify subtleties in customer/client and/or business partner interactions.</li><li>
Ability to present information necessary to propose a claim resolution to stakeholders.</li></ul> 
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply&mdash;your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $59,900.00 - $98,200.00, with short-term incentive bonus eligibility set at 10%. 
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.] 
Why Zurich?
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment&mdash;so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500&reg;. 
Join us for a brighter future&mdash;for yourself and our customers. 
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets. 
Zurich complies with 18 U.S. Code &sect; 1033. 
Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.
Location(s): AM - Addison, AM - Albuquerque, AM - Atlanta, AM - Boston, AM - Center Valley, AM - Chicago, AM - Dallas, AM - Ft. Lauderdale, AM - Gold River, AM - Houston, AM - Irvine, AM - Las Vegas, AM - Maitland, AM - New York, AM - Omaha, AM - Overland Park, AM - Owings Mills, AM - Parsippany, AM - Pasadena, AM - Philadelphia, AM - Pittsburgh, AM - Rocky Hill, AM - Schaumburg, AM - Woodland Hills 
Remote Working: Hybrid 
Schedule: Full Time 
Employment Sponsorship Offered: No 
 
Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID</div>

General Liability Claims Specialist II

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