Claims Eligibility Specialist I - Hybrid (Dispute Resolution)

MET Healthcare Solutions

Houston (TX)

Hybrid

USD 42,000 - 56,000

Full time

5 days ago

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Job summary

MET Healthcare Solutions is seeking a Claims Eligibility Specialist I in Houston, Texas (hybrid). You will analyze level I claims information to determine eligibility for the dispute resolution process in line with federal regulations and company policies.

The role involves reviewing EOBs and remittance documents, drafting regulatory-compliant correspondence, and maintaining meticulous claim files. Strong attention to detail and excellent written and verbal communication are required, as is the

Qualifications

Experience analyzing medical claims and EOBs to determine eligibility for dispute resolution.
Excellent written and verbal communication with regulatory clarity.
Ability to work across multiple operating systems and maintain confidentiality.

Responsibilities

Analyze EOBs and remittance documents to determine eligibility for dispute resolution.
Draft correspondence in compliance with regulatory requirements and internal policies.
Stay updated on industry regulations and align strategies accordingly.
Maintain organized physical and electronic claim files.
Review various claim types (HCFA 1500, UB92, etc.) and understand reimbursement rules.
Communicate clearly to explain reasoning and outcomes.