Human Resources Specialist - Claims

Collin County Mental Health Retardation Center; McKinney (TX); On-site; USD 33,000 - 34,000; Full time

Job summary

Collin County Mental Health Retardation Center in McKinney, TX 75069 seeks a full-time Claims Specialist to review, investigate, process, and resolve insurance claims accurately and in compliance with policies.

Responsibilities include reviewing incoming claims for completeness, gathering documentation, verifying coverage, processing claims, and escalating discrepancies or potential fraud. Strong analytical and communication skills are essential.

Qualifications

• Minimum of a HS Degree or GED; some college preferred.
• Minimum 2 years in claims processing or related field.
• Strong analytical and problem-solving skills.
• High attention to detail and organizational abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent computer skills in MS Office.
• Excellent oral and written communication skills.
• Excellent interpersonal skills with tact and diplomacy.
• Ability to present to groups and instruct software use.

Responsibilities

• Review and evaluate incoming claims for completeness, accuracy, and eligibility.
• Investigate claims by gathering and analyzing supporting documentation.
• Verify coverage, policy provisions, contracts, or applicable guidelines.
• Process claims in accordance with procedures and regulatory requirements.
• Identify discrepancies, potential fraud, or missing information and escalate as needed.
• Additional duties as assigned.

Skills

Claims processing

Analytical skills

Attention to detail

Multitasking

MS Office

Communication skills

Interpersonal skills

Education

HS Degree or GED

Some college preferred

Tools

MS Office

Job description

Job Details

Job Location: McKinney, TX 75069Position Type: Full TimeSalary Range: $24.03 HourlyWorks under the direction of the Human Resources Assistant Director and Human Resources Director with moderate latitude for the use of initiative and independent judgment. The claims specialist is responsible for reviewing, investigating, processing, and resolving claims accurately and efficiently while ensuring compliance with company policies.

• Review and evaluate incoming claims for completeness, accuracy, and eligibility.
• Investigate claims by gathering and analyzing supporting documentation.
• Verify coverage, policy provisions, contracts, or applicable guidelines.
• Process claims in accordance with company procedures and regulatory requirements.
• Identify discrepancies, potential fraud, or missing information and elevate when appropriate.
• Additional duties as assigned.

Qualifications

• Minimum of a HS Degree or GED, some college preferred, but not required.
• Minimum of 2 years of experience in claims processing, customer service, insurance, healthcare, or related administrative field.
• Strong analytical and problem-solving skills.
• High attention to detail and organizational abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent computer skills in MS Office.
• Excellent oral and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy,
• Ability to present to a small or large group of new and current workforce members.
• Ability to instruct others in the use of computer and applicable software programs.