Insurance Specialist

Key Responsibilities

• Follow up on claim status via insurance portals or calls to payers to determine adjudication and details.
• Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage.
• Verify patient insurance eligibility and coordination of benefits.
• Review and analyze payer correspondence.
• Investigate electronic claim rejections.
• Submit claims for processing corrections, to secondary insurances, or to updated addresses.
• Research requests for insurance payment retractions.
• Monitor and notify management of payer trends and/or claim processing issues.

Education/Experience

• A High School diploma or GED.
• Previous health insurance billing experience.
• Working knowledge of medical terminology.
• Strong problem-solving skills and the ability to adapt to changes in policies, regulations, and procedures.
• Excellent written and verbal communication skills.
• A high attention to detail.
• The ability to interact effectively with others.
• The ability to maintain confidentiality.
• Proficient computer skills with knowledge of Microsoft Word and Excel.