Claims Specialist

Planstin Administration; St. George (VT); On-site; USD 48,000 - 72,000; Full time

Benefits offered by this job

12 paid holidays

3 weeks paid time off

Health, dental, vision, and accident保险

401k with 4% match

Free snacks and lunches onsite

Free Primestin Care Clinic membership

Job summary

Planstin Administration in Southern Utah is seeking a detail-oriented Claims Specialist to review and process medical, dental, and vision claims, help members and providers navigate the reimbursement process, and ensure accuracy and timely payments.

You will work with internal teams, maintain records, identify discrepancies, and support claims workflows while upholding productivity and quality standards, with opportunities to contribute to process improvements.

Qualifications

• Experience in claims and/or billing.
• Understanding of medical terminology.
• Basic knowledge of healthcare concepts including network status, reference base pricing / UCR, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, and plan variations.
• ICD-10, CPT, HCPCS, CDT knowledge.
• Basic understanding of coordination of benefits.
• Must be a team player yet able to work independently.
• Ability to multi-task and prioritize.
• Knowledge of appeal and subrogation is preferred.

Responsibilities

• Review and process medical, vision, and dental claims.
• Maintain a clear understanding of all current plans and their benefit features.
• Maintain required productivity and quality standards.
• Identify process improvement opportunities.
• Send and track medical record requests.
• Communicate with healthcare providers and members around claim and reimbursement status and requirements.
• Maintain accurate records of claims and reimbursements.
• Identify and correct discrepancies in claims.
• Send and track provider refund requests.
• Ensure timely reimbursement for services.
• Monitor claim status and follow up on outstanding claims.
• Serve as a backup for clerk tasks during employee absences.
• Answer questions and provide resources to different team members.
• Other duties as assigned.

Skills

Claims/billing experience

Medical terminology

Coordination of benefits

Time management

Team player

Independent worker

Tools

ICD-10

CPT

HCPCS

CDT

Job description

Located in Southern Utah, Planstin is at the forefront of benefits administration and business services. We simplify health insurance for employers and individuals, emphasizing cost-effectiveness and excellent service in a complex market. As our company grows, we’re looking for talented individuals eager to progress in their careers.

About the role

We’re looking for a detail-oriented Claims Specialist to join our team. This role is a great fit for someone who understands healthcare claims, enjoys solving problems, and takes pride in helping members and healthcare providers navigate the claims and reimbursement process.

As a Claims Specialist, you’ll review and process medical, dental, and vision claims while helping ensure claims are handled accurately and reimbursements are completed in a timely manner. You’ll work closely with members, healthcare providers, and internal teams to research claim issues, resolve discrepancies, and provide clear information about claim and reimbursement requirements.

What you'll do

• Review and process medical, vision, and dental claims.
• Maintain a clear understanding of all current plans and their benefit features.
• Maintain required productivity and quality standards.
• Identify process improvement opportunities.
• Send and track medical record requests.
• Communicate with healthcare providers and members around claim and reimbursement status and requirements.
• Maintain accurate records of claims and reimbursements.
• Identify and correct discrepancies in claims.
• Send and track provider refund requests.
• Ensure timely reimbursement for services.
• Monitor claim status and follow up on outstanding claims.
• Serve as a backup for clerk tasks during employee absences.
• Answer questions and provide resources to different team members.
• Other duties as assigned.

Qualifications

• Experience in claims and/or billing
• Understanding of medical terminology
• Basic knowledge of healthcare concepts including network status, reference base pricing / UCR, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, and plan variations
• ICD-10, CPT, HCPCS, CDT knowledge
• Basic understanding of coordination of benefits
• Must be a team player yet able to work independently
• Ability to multi-task and prioritize
• Knowledge of appeal and subrogation is preferred

Planstin's Employee Benefits:

• 12 paid holidays plus 3 weeks of paid time off to balance work and life.
• Comprehensive insurance coverage including health, dental, vision, and accident plans tailored for your well-being.
• Free membership for you and your dependents to Primestin Care Clinic.
• Invest in your future with a 401k plan backed by a solid 4% match from us.
• Free snacks and regular lunches available onsite.