Medical Claims Specialist
Tyler, TX 75703
Under the direction of the CFO, you will be responsible for working all insurance claims over 45 days and work all denied claims for Commercial, State Agency, and Worker's Compensation.
Job Responsibilities & Duties
• Examine claims records and forms to determine whether the patient has medical insurance.
• Review provisions of certificate or policy to determine the patient's included medical coverage losses.
• Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable.
• Complete logs, reports, forms and records to properly document medical claims.
• Reject or accept documentation, determine benefits due, and start the denial or payment process to resolve medical claims.
• Adhere to all company policies, procedures, and guidelines in addition to insurance regulations at the federal and state level.
• Examine medical treatment records, police reports, physical property damage and medical bills to gauge the overall extent of liability.
• Interview and communicate with claimants, police, witnesses, physicians and other necessary individuals to decide claim denial, settlement or review.
• Ensure all claims information remains confidential.
• Engage in continuing education and training opportunities when possible.
Skills & Qualifications
• At least a bachelor's degree
• At least 5 years of experience working in the medical field
• At least 5 years of experience as a medical claims specialist/examiner
• Interpersonal skills
• Analytical abilities
• Data entry skills
• Experience working with multiple insurance companies.
Salary: $17.00 / hr. This position is a full-time, fully benefited work opportunity!
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