Healthcare Claims Specialist

2 weeks ago


Miami, Florida, United States Secure Eclaims LLC Full time
Position Overview

The Healthcare Claims Specialist plays a crucial role in ensuring the accuracy and appropriateness of medical billing processes. This position involves a thorough examination of medical and surgical charges to confirm their validity and necessity.

Key Responsibilities
  • Billing Review: Conduct comprehensive reviews of all medical and surgical billings to ensure charges are reasonable and necessary. Analyze coding for operative reports, procedures, and complex surgeries.
  • Length of Stay Evaluation: Assess hospital length of stay to determine the appropriateness of care provided and recommend suitable payment resolutions for any billing disputes.
  • Second Review Process: Provide an additional review of bills that have raised questions regarding the appropriateness of authorized payments.
  • Claims Evaluation: Evaluate claims that require medical management and make informed recommendations for follow-up actions, further investigations, or necessary documentation.
  • Training and Support: Mentor and support claims staff in understanding quality healthcare cost containment and conducting utilization reviews effectively.
Company Overview

Secure Eclaims LLC is a leading specialty benefits management organization dedicated to enhancing healthcare delivery in Puerto Rico and South Florida. Our innovative care management model aligns the interests of providers, payors, and members, ensuring the provision of high-quality, cost-effective healthcare services.

We are committed to developing a care delivery model that reflects traditional values while integrating modern technology and flexibility. Our extensive experience in the healthcare sector positions us to improve health outcomes, achieve significant cost savings, and serve as a pivotal point of contact in the transition to value-based care.



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