Claims Specialist - Remote

Lensa; Milwaukee (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Claims Specialist to join their dynamic team. In this entry-level role, you will be responsible for reviewing and processing claims, ensuring compliance with program requirements, and enhancing client relationships. This position offers a unique opportunity to develop your skills in the healthcare sector while working in a supportive environment. You'll engage with clients, resolve reimbursement issues, and maintain accuracy in claims processing. If you're looking for a role that combines analytical skills with customer service, this is the perfect opportunity for you.

Benefits

Health insurance

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 required.
• Knowledge of medical billing procedures and coding is essential.

Responsibilities

• Analyze and process claims for accuracy and eligibility.
• Maintain relationships with clients and assist with reimbursement issues.

Skills

Group Health Insurance knowledge

Workers' Compensation knowledge

No-Fault knowledge

Liability industry knowledge

Medical terminology knowledge

CPT and ICD coding knowledge

Healthcare billing practices knowledge

Time-management skills

Analytical skills

Customer-service orientation

Oral and written communication skills

Interpersonal skills

Conflict resolution skills

Attention to detail

Education

High school diploma

Associate’s degree

Bachelor’s degree

CPC certification

CCS certification

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Rising Medical Solutions, is seeking professionals. Apply via Lensa today!

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 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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  IT Services and IT Consulting

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