Medical Claims Specialist | DailyPay & Growth

ZENOVA; Franklin (TN); On-site; USD 65,000 - 75,000; Full time

Job summary

Wellpath is seeking a Claims Specialist to accurately process medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory requirements. The role focuses on reviewing, verifying, and analyzing claim information to determine payment or denial.

This position involves processing new, pended, edited, and returned claims to ensure resolution and timely completion, while communicating with internal teams, providers, payers, and Claims Leadership to support

Qualifications

• 3-5 years of medical claims processing experience.
• Familiarity with CPT/HCPCS and ICD-10 coding.
• Strong customer service and communication skills.
• Proficiency in the Microsoft Office Suite (Outlook, Word, Excel).
• High level of attention to detail with strong organizational skills.
• Experience in a high-volume claims environment.

Responsibilities

• Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates.
• Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance.
• Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up.
• Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers.
• Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service.

Skills

Medical claims processing

CPT/HCPCS coding

ICD-10 coding

Customer service

Communication skills

Microsoft Office

Education

High school diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Wellpath is seeking a Claims Specialist to accurately process medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory requirements. The role focuses on reviewing, verifying, and analyzing claim information to determine payment or denial.

This position involves processing new, pended, edited, and returned claims to ensure resolution and timely completion, while communicating with internal teams, providers, payers, and Claims Leadership to support