Medical Claims Specialist

4 weeks ago


Tulsa, Oklahoma, United States Innova Solutions Full time
Job Summary

Innova Solutions is seeking a highly skilled Medical Claims Representative to join our team. As a Medical Claims Representative, you will be responsible for analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes.

Key Responsibilities
  • Analyze and process provider data to ensure accuracy and compliance with business rules
  • Research and resolve issues related to provider information, claims processing, and membership assignment
  • Develop and maintain training materials for team members on business rules and network contracting
  • Identify gaps in processes and suggest process improvement strategies
  • Collaborate with management to implement special projects and manage workflow
Requirements
  • Bachelor's degree plus 1 year of experience with provider network contracting and credentialing systems or 5 years of experience in the healthcare industry
  • Excellent written and verbal communication skills, including interpersonal skills
  • Experience with Microsoft Office software products, including analytical tools and report development
  • Subject matter expertise in professional provider credentialing process
  • 2 years of experience with current government-sponsored health insurance networks
Benefits

Innova Solutions offers a comprehensive benefits package, including medical and pharmacy coverage, dental and vision insurance, 401(k), health savings account (HSA), flexible spending account (FSA), life insurance, pet insurance, short-term and long-term disability, accident and critical illness coverage, pre-paid legal and ID theft protection, sick time, and other types of paid leaves (as required by law), employee assistance program (EAP).

About Innova Solutions

Innova Solutions is a global technology and business transformation solutions provider, employing approximately 50,000 professionals worldwide and reporting an annual revenue approaching $3 Billion. We deliver strategic solutions to our clients, enabling them to operate as leaders within their fields.



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