Claims Specialist

About the role

This role is critical to maximizing reimbursement, reducing denials, and supporting the financial health of the diagnostic laboratory. The Claims Specialist manages the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims.

Responsibilities

• Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.
• Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions.
• Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment.
• Maintain accurate records of claim status, correspondence, and payer responses in the billing system.
• Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional revenue cycle management (RCM) initiatives.
• Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims.
• Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making.

Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred).
• 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.
• Strong knowledge of insurance billing, payer requirements, and denial management.
• Familiarity with laboratory coding (CPT, ICD-10), Explanation of Benefits (EOBs), and remittance advice.
• Proficiency with billing software and Microsoft Office Suite.
• Excellent attention to detail, organizational, and communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Work Environment

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs.

Physical Demands

• Sitting for extended periods (up to 8 hours per day).
• Repetitive use of hands and fingers for typing and mouse operation.
• Visual acuity for reading computer screens and documents.
• Ability to communicate effectively via phone and video calls.
• Occasional lifting of up to 10 pounds (office supplies, equipment).

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Pay

Budgeted range: $34—$37 USD per hour.

Culture

At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day—and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. Here’s what you can expect day to day:

• Play like a champion (step up, redefine what’s possible, own it): We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments—with quality, speed, and care.
• Think bigger (stretch beyond, courage not consensus): We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls—choosing progress over perfection.
• Grow fast (be curious, speak up, be agile): We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.

If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.