Claims Specialist in Irvine, California at True Behavioral Health LP

FR Health is seeking a detail-oriented and experienced Claims Specialist to manage insurance claims from submission through resolution. This role is responsible for ensuring claims are processed accurately, efficiently, and in compliance with company policies and applicable regulations.

Schedule: Monday through Friday 9:00am to 5:30pm

Key Responsibilities

• Review and process claims for accuracy, completeness, and compliance.
• Evaluate claims using medical records, reports, and supporting documentation.
• Coordinate with Finance to ensure timely and accurate claim payments.
• Investigate complex claims, discrepancies, and potential fraud or risk concerns.
• Maintain accurate claims records and supporting documentation.
• Ensure compliance with company policies, industry standards, and legal requirements.
• Prepare reports on claims status, processing times, and trends.
• Perform other duties as assigned.

Qualifications

• 2–3 years of experience in claims processing or a related field.
• Working knowledge of insurance policies, claims procedures, and industry regulations.
• Strong attention to detail, analytical, and problem-solving skills.
• Excellent communication and customer service skills.
• Strong organizational and time-management abilities.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Experience with claims management systems such as Guidewire, VUE, or similar platforms preferred.
• Ability to manage multiple priorities in a fast-paced environment.