This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
We are looking for a detail-oriented Medical Insurance Claims Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of claims processing within the healthcare industry. Working remotely but closely with the team based in San Diego, California, you will help support better financial and member outcomes while contributing to a collaborative and fast-paced environment.
Job Responsibility:
Conduct audits of pre-lag reports to verify accuracy, completeness, and compliance with established turnaround times
Investigate and resolve member out-of-pocket concerns to ensure proper claims adjustments
Monitor daily pre-lag reports for assigned regions and escalate compliance issues as needed
Analyze daily, weekly, and check-run reports for assigned IPAs to identify potential errors or inconsistencies
Notify management promptly about compliance concerns related to claims payment timelines
Perform quality reviews of claims processes to ensure adherence to organizational standards
Collaborate with team members to identify trends and root causes of recurring issues
Assist with benefit interpretation and claims adjustments using EZCap or similar platforms
Maintain documentation and provide detailed audit reports to support continuous improvement initiatives
Support the implementation of quality measures and compliance protocols within claims operations
Requirements:
High School diploma or equivalent is required
Minimum of 2 years of experience in claims processing, healthcare operations, or related administrative functions
Strong knowledge of medical billing, insurance eligibility, and claims adjudication
Proficiency in EZCap or similar claims management platforms
Excellent attention to detail and ability to identify errors in complex data sets
Effective communication skills for resolving member concerns and collaborating with team members
Ability to analyze trends and recommend solutions for process improvements
Familiarity with compliance requirements and quality assurance standards in the healthcare industry
What we offer:
medical, vision, dental, and life and disability insurance