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Healthcare Claims Specialist
2 months ago
Position Overview:
Randstad is currently seeking a qualified Healthcare Claims Specialist to join a prominent healthcare organization. This role is essential for managing and processing medical claims efficiently.
Job Responsibilities:
As a Healthcare Claims Specialist, your primary duties will include:
- Reviewing and adjudicating medical claims for approval or denial.
- Conducting thorough research on claims to ensure all necessary documentation is provided.
- Analyzing data and applying benefit criteria for accurate payment processing.
- Addressing inquiries and resolving issues raised by vendors and members.
- Ensuring compliance with relevant county, state, and federal regulations.
- Collaborating with internal departments to facilitate claim resolution.
Qualifications:
The ideal candidate will possess:
- A minimum of 2 years of experience in claims processing.
- Strong knowledge of medical terminology, including ICD-10 and CPT coding.
- Proficiency in Microsoft Word and Excel.
Skills Required:
Key skills for success in this role include:
- Claims Processing
- Claims Adjudication
- Data Analysis
- Medical Billing
- Effective Communication
Work Environment:
This position requires full onsite presence and operates during standard business hours.
Equal Opportunity Employer:
Randstad is committed to creating a diverse environment and is proud to be an equal opportunity employer. We welcome applicants from all backgrounds and experiences.
For more information about this opportunity and to explore additional roles, please connect with Randstad.
