Claims Specialist II: COB & Denial Resolution Pro

Tier4 Group; Baton Rouge (LA); On-site; USD 42,000 - 64,000; Full time

Job summary

Tier4 Group in Baton Rouge seeks a Claims Specialist II to join our healthcare operations team. The role focuses on accurate medical claims processing, benefits coordination, and strong COB knowledge to determine primary vs secondary payers.

You will investigate discrepancies, recover overpayments, and collaborate with members, providers, and internal teams to maintain high-quality service and financial accuracy.

Qualifications

• Minimum two years of medical claims processing experience.
• Strong analytical and investigative skills to resolve complex claims.
• Excellent written and verbal communication abilities.
• Ability to prioritize tasks in a fast-paced environment.

Responsibilities

• Review and process medical claims with accuracy and attention to detail.
• Research and resolve claim edits, denials, and payment discrepancies.
• Determine primary vs. secondary coverage when multiple plans exist.
• Apply COB rules, including subscriber status and dates.
• Update claims and coverage records for accurate adjudication.
• Investigate prior processed claims and adjust benefits as needed.
• Identify and recover overpayments through refunds and reprocessing.
• Communicate with members, providers, and carriers to resolve issues.
• Assist with quality audits and process improvements.

Skills

Medical claims processing

Analytical skills

Investigative skills

Communication skills

Multitasking

MS Office proficiency

Education

High School Diploma or equivalent

Tools

Claims processing systems

Microsoft Office

Job description

Tier4 Group in Baton Rouge seeks a Claims Specialist II to join our healthcare operations team. The role focuses on accurate medical claims processing, benefits coordination, and strong COB knowledge to determine primary vs secondary payers.

You will investigate discrepancies, recover overpayments, and collaborate with members, providers, and internal teams to maintain high-quality service and financial accuracy.