Claims Resolution Specialist — Remote

Coastal Cardiology PC; Pearland (TX); Hybrid; USD 57,308,000 - 103,155,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Incentives and recognition programs

Job summary

Kelsey-Seybold Clinic in Pearland, TX is seeking a Claims Adjustment Specialist to review and adjust claims, investigate discrepancies, and collaborate with processing teams to ensure accurate payments and timely resolutions.

The role requires 2+ years in claims adjudication, proficiency with claim systems such as EPIC/Centricity, and strong attention to detail. Hybrid work options are available with on-site meetings as needed.

Qualifications

• High School Diploma or GED is required.
• 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment.
• Working knowledge of claim adjudication workflows and benefit interpretation.
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking.
• Ability to interpret claim data, supporting documentation, and payer requirements.
• Ability to work independently while managing multiple priorities.
• Strong attention to detail and accuracy in documentation.

Responsibilities

• Review claims for adjustment due to processing errors, updated documentation, or system changes.
• Analyze claim history, benefit plans, and prior adjudication to determine adjustments.
• Perform claim corrections, reversals, and reprocessing per internal policies and regulatory guidelines.
• Validate accurate payment or denial outcomes following adjustments.
• Investigate discrepancies and document actions within the claims system.
• Provide explanations for adjustment decisions when required.
• Collaborate with Claims Processing, QA, Training, Escalations, and other teams as needed.
• Identify trends and areas for process improvement.

Skills

Claims adjudication

Documentation

Attention to detail

Microsoft Office

Education

High School Diploma or GED

Tools

EPIC

Centricity

Job description

Kelsey-Seybold Clinic in Pearland, TX is seeking a Claims Adjustment Specialist to review and adjust claims, investigate discrepancies, and collaborate with processing teams to ensure accurate payments and timely resolutions.

The role requires 2+ years in claims adjudication, proficiency with claim systems such as EPIC/Centricity, and strong attention to detail. Hybrid work options are available with on-site meetings as needed.