Medical Claims Specialist

6 days ago


Fairfax, Virginia, United States Three Point Solutions Full time
Job Summary

Job Title: Medical Claims Specialist

About the Role

We are seeking a highly detail-oriented and organized Medical Claims Specialist to join our team at Three Point Solutions. As a Medical Claims Specialist, you will play a critical role in reviewing and adjudicating paper and electronic claims, ensuring they are handled according to our organizational policies and procedures.

Key Responsibilities

  • 60%:
    Examine and resolve non-adjudicated claims, process product/system-specific claims, calculate deductibles, and ensure timely payments using automated systems.
  • 25%:
    Conduct research and apply training materials, medical policies, and procedures to process claims accurately, collaborate with the Quality team and leadership for clarity on procedures, and participate in ongoing training.
  • 10%:
    Complete daily productivity reports used for scheduling, quality improvement, and financial planning.
  • 5%:
    Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

Requirements

  • Education:
    High School Diploma or GED required.
  • Experience:
    Less than one year of experience in processing claim documents required. Preferred: 1-3 years of experience in claims processing, billing, or medical terminology.

Skills and Abilities

  • Analytical skills Proficient
  • Reading comprehension and ability to follow directions Proficient
  • Basic written/oral communication skills Proficient
  • Ability to navigate computer applications Proficient

Additional Requirements

  • Must disclose any event that makes them ineligible for work on Federal health care programs.
  • Ability to work in a fast-paced environment with changing priorities, deadlines, and workloads.
  • Must meet deadlines and handle multiple customer service demands effectively.
  • Ability to communicate positively with both internal and external customers, including challenging situations.


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