W

Wellpath

Outsourced correctional healthcare services provider

Claims Specialist

Claims AdjudicationConfirmed live in the last 24 hours
Full-timeFranklin, TN, USANo salary listed

About the Job

Requirements

  • A high school diploma or GED is required.
  • Three to five years of medical claims processing experience is required.
  • Working knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Tenth Revision (ICD-10) coding standards.
  • Familiarity with Centers for Medicare & Medicaid Services (CMS) guidelines and regulations.
  • Strong customer service and communication skills.
  • Proficiency in Microsoft Office Suite, including Outlook, Word, and Excel.
  • Ability to work in a high-volume claims environment.
  • Applicants must reside in the United States.

Responsibilities

  • Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates.
  • Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance.
  • Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up.
  • Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers.
  • Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service.

About the Company

Wellpath

Outsourced correctional healthcare services provider

Wellpath provides outsourced healthcare for inmates in the United States and Australia through government contracts, covering medical, dental, optical, and mental health services. Its offerings include primary care, chronic disease management, substance abuse and detox programs, suicide prevention, pharmaceutical management, and administrative tasks such as revenue cycle management, all using its proprietary ERMA electronic records system. The company operates at scale with divisions serving local jails, state and federal prisons, and inpatient facilities, reaching about 300,000 patients daily across more than 550 facilities. Its goal is to deliver comprehensive, contract-based correctional healthcare while navigating sector challenges like debt, rising labor costs, and litigation risk.

Company size
1,001-5,000
Company stage
Early VC
Total funding
$10.7M
Headquarters
Nashville, TN
Founded
2006

Recently Posted Jobs

Explore more opportunities at Wellpath

See more jobs