Claims Specialist

ZENOVA; Franklin (TN); On-site; USD 65,000 - 75,000; Full time

Job summary

Wellpath is seeking a Claims Specialist to accurately process medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory requirements. The role focuses on reviewing, verifying, and analyzing claim information to determine payment or denial.

This position involves processing new, pended, edited, and returned claims to ensure resolution and timely completion, while communicating with internal teams, providers, payers, and Claims Leadership to support

Qualifications

• 3-5 years of medical claims processing experience.
• Familiarity with CPT/HCPCS and ICD-10 coding.
• Strong customer service and communication skills.
• Proficiency in the Microsoft Office Suite (Outlook, Word, Excel).
• High level of attention to detail with strong organizational skills.
• Experience in a high-volume claims environment.

Responsibilities

• Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates.
• Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance.
• Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up.
• Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers.
• Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service.

Skills

Medical claims processing

CPT/HCPCS coding

ICD-10 coding

Customer service

Communication skills

Microsoft Office

Education

High school diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

You Matter

• Make a difference every day in the lives of the underserved
• Join a mission driven organization with a people first culture
• Excellent career growth opportunities

Join us and find a career that supports:

• Caring for overlooked, underserved, and vulnerable patients
• Autonomy in a warm team environment
• Growth and training

Perks and Benefits

In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including:

• DailyPay, receive your money as you earn it!
• Tuition Assistance and dependent Scholarships
• Employee Assistance Program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax free Health Spending Accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan.

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Claims Specialist is responsible for the accurate and timely processing of medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory requirements. The role focuses on reviewing, verifying, and analyzing claim information to determine appropriate payment or denial. This position involves processing new, pended, edited, and returned claims to ensure resolution and completion. The Claims Specialist analyzes and resolves denials, rejections, and payment discrepancies while maintaining quality and turnaround standards. The role also includes communicating with internal teams, providers, payers, and Claims Leadership to support efficient and accurate claim processing.

Key Responsibilities

• Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates.
• Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance.
• Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up.
• Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers.
• Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service.

Qualifications & Requirements

Education

• High school diploma or GED required

Experience

• 3-5 years of medical claims processing experience required.
• Working knowledge of CPT/HCPCS and ICD-10 coding standards.
• Familiarity with CMS guidelines and regulations.
• Strong Customer service and communication skills.
• Proficiency in the Microsoft Office Suite (Outlook, Word, Excel).
• High level of attention to detail with strong organizational skills.
• High-volume claims environment.

Licenses/Certifications

• None required

This position is available only to those who reside in the United States.

We are an Equal Employment Opportunity Employer

We value the contributions of team members with a broad range of experiences, skills, and perspectives and are committed to providing equal employment opportunity for all.