Manages and evaluates insurance claims to ensure accurate coverage determination and timely processing. Investigates claims, reviews documentation, and responds to inquiries from claimants, providers, and payers.
Assists clients in submitting claims correctly and collaborates with internal teams to support efficient resolution. Maintains detailed records, verifies compliance with regulatory and organizational standards, and supports audit readiness.
Plays a key role in optimizing cash application processes, resolving discrepancies, and improving overall revenue cycle performance.
Responsibilities
Key Responsibilities:
• Manage and evaluate insurance claims to ensure accuracy and timely processing
• Investigate claims and negotiate settlements in accordance with policy guidelines
• Respond to inquiries from claimants and other related parties in a timely and professional manner
• Assist clients with accurate and complete claim submission
• Coordinate with internal teams to facilitate efficient claim resolution
• Maintain detailed records and ensure compliance with audit standards and regulatory requirements
Qualifications
Minimum Qualifications
• High school diploma or equivalent required
• 2+ years of experience in insurance claims processing or related support
• Working knowledge of insurance policies, coverage, and claim adjudication processes
• Experience investigating, resolving, and following up on claim issues
• Strong communication and customer service skills
• Ability to maintain detailed records and ensure compliance