Claims Specialist

Job Description

Job Description

Salary : $40,000-$60,000 annual

We are seeking a highly skilled and detail-oriented Claims Specialist with expertise in handling No-Fault, Worker's Compensation and all other medical insurance claims. The ideal candidate must have 3+ years experience and will have a thorough understanding of regulatory requirements and processes associated with these types of claims, along with excellent communication and problem-solving skills. Must be available for employment Monday-Friday for 9a-5p employment.

Responsibilities :

• Manage and process No-Fault insurance claims, including reviewing claim submission, verifying coverage, and ensuring compliance with regulatory guidelines.
• Handle Worker's Compensation claims from initial filling through resolution, including investigating incidents, gathering relevant documentation, and coordinating with legal counsel as needed.
• Conduct through investigation into claim validity, including medical records, and other relevant documentation.
• Communicate effectively with claimants, insurance adjuster, and other stakeholders to facilitate the claims process and resolve issues in a timely manner.
• Maintain accurate and up-to-date claim files and documentation, ensuring compliance with internal policies and regulatory requirements.
• Obtain and verify insurance information for patients, including primary and secondary coverage, policy numbers, group numbers, and policy holder information.
• Liase with insurance companies and third-party payers to confirm coverage details, policy benefits, and pre-authorization requirements.
• Collaborate with medicalbillingteam to ensure accurate timely submission of claims and pre-authorizations.
• Resolve insurance related issues and discrepancies, including denials and rejections, through effective communication and follow-up with insurance carriers.
• Educate patients on insurance benefits, coverage limitations, and financial responsibilities, providing assistance with insurance inquiries and concerns.
• Verify patient insurance coverage and eligibility.
• Assist patients with insurance-related inquiries, explaining coverage details, copays, deductibles, and out-of-pocket expenses.
• Prepare and submit insurance claims and billing statements.
• Maintain confidentiality of patient information and ensure compliance with HIPAA regulations in all administrative activities.

Qualifications :