Claims Specialist

Job#: 3008978 Job Description: Claims Specialist OverviewWe are seeking two experienced Claims Specialists to join our growing team. This expansion is driven by anticipated increases in business volume and a strategic focus on enhancing operational capacity. These roles are critical to ensuring the accuracy and integrity of our claims processing systems and supporting our commitment to high-quality service delivery.Role SummaryThis is not a traditional high-volume claims processing role. Instead, it emphasizes problem-solving, root cause analysis, and quality assurance. The Claims Specialist will investigate claim issues, collaborate with configuration teams, and contribute to process improvements that ensure accurate and efficient claims handling.Key ResponsibilitiesInvestigate claims that fail to process correctly and identify root causes.Create and manage tickets for configuration fixes; provide actionable recommendations to the configuration team.Analyze and suggest appropriate treatment groupings for coding discrepancies.Conduct provider searches and validate network relationships.Draft and maintain desktop procedures and process documentation.Test system changes and configuration updates.Process and review both facility (UB-04) and professional (CMS-1500) medical claims.Required QualificationsMinimum 3 years of relevant experience in claims analysis or quality review.Commercial insurance experience is mandatory. Candidates with only DME, behavioral health, or dental claims experience will not be considered.Strong understanding of provider networks and their impact on payment processing.Proven ability to troubleshoot claims errors and recommend effective solutions.Experience in:Claims quality reviewsTesting environments or system validationProcess documentationPreferred QualificationsCPC certification (Certified Professional Coder) is highly desirable.Demonstrated ability to work independently and conduct thorough research before escalating issues.Strong analytical thinking and attention to detail.Ideal Candidate TraitsProactive and resourceful problem-solverDetail-oriented with a commitment to accuracyCollaborative mindset with strong communication skillsComfortable working in a dynamic, growth-oriented environment Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.