Claims Specialist

About the role

Make a difference every day in the lives of the underserved. Join a mission driven organization with a people first culture offering excellent career growth opportunities. Work in autonomy within a warm team environment with growth and training. Join Us And Find a Career That Supports Caring for overlooked, underserved, and vulnerable patients. Why Us: Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

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.

Qualifications

• Education: High school diploma or GED required.
• Experience: 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.
• Ability to work in a high-volume claims environment.
• Licenses/Certifications: None required.
• This position is available only to those who reside in the United States.

Skills

• Customer service and communication skills.
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel).