Medical Claims Specialist I-Hybrid

4 days ago


Houston, Texas, United States MET Healthcare Solutions Full time
Job Summary

MET Healthcare Solutions is seeking a skilled Claims Eligibility Specialist I to analyze level I claims information and determine eligibility in the dispute resolution process. The ideal candidate will have experience reviewing medical claims, EOBs, and payment remittances, as well as a strong understanding of insurance reimbursement rules.

Responsibilities of the Claims Eligibility Specialist I include:

  • Analyzing EOBs and payment remittance documents to determine eligible claims for dispute resolution.
  • Composing correspondence in accordance with regulatory requirements and company policies.
  • Staying up-to-date on industry-specific regulations and implementing effective strategies.
  • Maintaining physical and electronic files for eligible claims.

The Claims Eligibility Specialist I position is a hybrid role, requiring presence in the corporate office 2-3 times per week. The ideal candidate will have strong written and verbal communication skills, with the ability to explain reasoning effectively.

This is a full-time position, Monday-Friday from 8am-5pm. The successful candidate will be able to meet the weekly expectations and requirements of the hybrid schedule.



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