Claims Specialist - Remote

Job description

Claims Specialist / Contract

✔️ Location: Remote, NY
✔️ Employment Type: Full-time, Contract
✔️ Hourly Rate: $39/hr

✅ Why Join Us
✔️ Compensation & Benefits: $39/hr, 1 week PTO after 3 months (2 weeks starting year 2), 6 major holidays, 5 sick days, license reimbursement, health insurance eligibility, 401k matching
✔️ Flexible & Remote: Work fully remote in a collaborative, fast-paced environment
✔️ Professional Growth: Gain hands-on experience with appeal/dispute adjudication, project management, and mentoring

✅ Qualifications
✔️ Bachelor’s or advanced degree in healthcare, business, management, digital studies, or related field
✔️ 2 years of collaborative project support preferred (new grads considered)
✔️ Proficiency with project management software, electronic documents, and design tools
✔️ Strong problem-solving skills and ability to collaborate across medical, analytical, and administrative teams
✔️ Excellent written and verbal communication, including professional phone etiquette
✔️ Ability to work independently, multitask, innovate, and meet tight deadlines

✅ Key Responsibilities
✔️ Serve as point-of-contact for appeal/dispute adjudication programs
✔️ Liaise with healthcare plans, providers, patients, and clients to coordinate documentation and requests
✔️ Monitor case status via client portals and conduct eligibility reviews
✔️ Track and assign cases using commercial and custom software applications
✔️ Facilitate clinical and coding reviews by reviewing case documentation with billers, nurses, physicians, and stakeholders
✔️ Monitor KPIs for timeliness, accuracy, and contract deliverables
✔️ Identify process roadblocks, recommend solutions, and execute approved actions
✔️ Present project status in huddles/scrums and schedule team meetings, recording decisions and next steps
✔️ Prepare billing invoices and coordinate with Finance for payment tracking
✔️ Mentor and train new staff on case progression and procedures
✔️ Perform additional duties as needed to support operations