Medical Claims Specialist — Make a Difference

Wellpath / Correct Care Solutions; Franklin (TN); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

DailyPay

Tuition Assistance

Employee Assistance Program (EAP)

Health Spending Accounts (HSA)

Wellness program

Banking partnership

Job summary

Wellpath / Correct Care Solutions is seeking a Claims Specialist to ensure accurate and timely medical claim processing based on established rules, coding standards, payer guidelines, and regulatory requirements.

You will review and resolve denials, communicate with internal teams and providers, and maintain high productivity with quality service while supporting a mission-driven healthcare environment focused on underserved populations.

Qualifications

• High school diploma or GED required.
• 3-5 years of medical claims processing experience required.
• Working knowledge of CPT/HCPCS and ICD-10 coding standards.
• Familiarity with CMS guidelines and regulations.
• 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.

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

Claims processing

CPT/HCPCS ICD-10

CMS guidelines

Customer service

MS Office

Education

High school diploma or GED

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

Wellpath / Correct Care Solutions is seeking a Claims Specialist to ensure accurate and timely medical claim processing based on established rules, coding standards, payer guidelines, and regulatory requirements.

You will review and resolve denials, communicate with internal teams and providers, and maintain high productivity with quality service while supporting a mission-driven healthcare environment focused on underserved populations.