Claims Specialist - Remote

Rising Medical Solutions; Milwaukee (WI); Remote; Full time

Job summary

An established industry player is seeking a Claims Specialist to join their team in Milwaukee. In this dynamic role, you will be responsible for reviewing, processing, and coordinating claims while ensuring compliance and enhancing client relationships. Your expertise in medical terminology and billing practices will be crucial as you analyze claims for accuracy and assist members with reimbursement issues. This innovative organization values teamwork and continuous improvement, offering a supportive environment where your contributions will be recognized. If you are detail-oriented and passionate about providing exceptional service in the healthcare sector, this opportunity is perfect for you.

Benefits

Health insurance (4 plans)

Dental insurance

Vision insurance

Paid time off (PTO)

401(k)

Life Insurance

Long-Term Disability Insurance

Flexible Spending Accounts (FSA)

Employee Assistance Program (EAP)

Professional Development Reimbursement Program

Qualifications

• 2-4 years of insurance or healthcare experience, preferably in claims or billing.
• CPC or CCS certification preferred for medical coding.

Responsibilities

• Analyze and process claims for accuracy, eligibility, and benefits coverage.
• Develop and maintain knowledge of medical bill processing and procedures.

Skills

Knowledge of Group Health Insurance

Medical terminology

CPT and ICD coding

Healthcare billing practices

Time-management skills

Analytical skills

Customer-service orientation

Oral and written communication skills

Interpersonal skills

Attention to detail

Education

High school diploma

Associate's or Bachelor's degree

CPC or CCS certification

Job description

The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships.

In this job, you will:

• Maintain ongoing knowledge of program requirements
• Analyze and process claims for accuracy, eligibility, and benefits coverage
• Retain and strengthen relationships with clients and members
• Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
• Correspond to verify if the amounts are related to the claim
• Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
• Adhere to quality assurance objectives and goals
• Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising's returns from administration services
• Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
• Keep management updated on activities, issues and developments
• Document all claims decisions and communications with members in the system accurately and timely
• Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
• Special projects as assigned by management

Reports to: Program Manager

Requirements

Education/Training

• High school diploma required; Associate's or Bachelor's degree preferred
• CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred

Experience

• 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s)

Skills/Competencies

• Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry
• Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
• Well-developed time-management, organization, and prioritization skills
• Excellent analytical skills
• Customer-service orientation
• Excellent oral and written communication skills
• Knowledge of medical billing procedures
• Ability to gather data, compile information, and prepare summary reports
• Strong interpersonal and conflict resolutions skills
• Ability to work independently and as part of a team in a fast-paced, multi-faceted environment
• Demonstrated persistence and attention to detail

Physical/Mental Demands:

• Remaining in a seated position
• Entering text or data into a computer
• Visual Acuity
• Talking
• Hearing
• Repetitive arm, hand, and finger motions
• Working remotely some or all of the time

Benefits

• Pay Range: $24-28.00
• Health insurance (4 different plans to choose from)
• Dental
• Vision
• Paid time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Rise Well Wellness Program
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work

About Us:

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we're committed to:

• Continuous technological improvement
• Entrepreneurial attitude
• Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's really important, and keeping a sense of humor
• Responding quickly to client needs
• Being the best, not the biggest