Insurance Claim Spec in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for an Insurance Claim Specialist in United States.

This role is central to ensuring the accuracy, compliance, and efficiency of the revenue cycle process within a healthcare environment. You will be responsible for managing patient account balances and ensuring timely, compliant submission and follow-up of insurance claims. The position plays a key role in maintaining financial performance by reducing claim delays, resolving denials, and supporting effective reimbursement processes. You will collaborate closely with internal teams, payers, and other stakeholders to ensure issues are resolved quickly and accurately. Strong attention to detail, customer service orientation, and knowledge of billing workflows are essential in this fast-paced operational setting. The role also requires continuous engagement with regulations and payer requirements to ensure compliance and optimal cash flow performance.

You will be responsible for managing end-to-end insurance claim processes and supporting revenue cycle operations to ensure timely reimbursement and account resolution. Key responsibilities include:

• Submit accurate and timely insurance claims to third-party payers while ensuring compliance with billing regulations.
• Review and resolve claim errors, edits, and discrepancies prior to submission.
• Conduct follow-up with insurance providers to resolve unpaid or denied claims and improve collections.
• Utilize payer portals and systems to verify claim status and perform account research.
• Assist with denial management, investigation, and resolution in collaboration with patient access and care teams.
• Maintain work queues, documentation, and billing records in alignment with productivity and quality standards.
• Support reporting activities, reconciliation tasks, and administrative duties related to revenue cycle operations.
• Ensure compliance with HIPAA and all applicable federal, state, and payer regulations.
• Deliver high-quality customer service to patients, providers, and internal stakeholders.
• Participate in training, meetings, and continuous improvement initiatives.

This role requires strong attention to detail, knowledge of medical billing processes, and excellent communication skills in a healthcare administrative environment. Candidates should have:

• High school diploma or equivalent required.
• 1+ year of experience in medical billing or medical office settings preferred.
• Understanding of revenue cycle operations and insurance claim processes.
• Familiarity with medical terminology and billing codes (ICD-10, CPT preferred).
• Strong written and verbal communication skills with excellent customer service abilities.
• Ability to manage multiple priorities with accuracy and efficiency in a fast-paced environment.
• Strong problem-solving skills and ability to resolve claim-related issues.
• Proficiency with computer systems, billing platforms, and payer portals.
• Knowledge of healthcare compliance standards including HIPAA.
• Ability to work independently while maintaining strong collaboration with team members.

• Competitive compensation aligned with experience and qualifications.
• Full-time, structured schedule (40 hours per week).
• Opportunity to work in a mission-driven healthcare environment supporting patient care access.
• Exposure to comprehensive revenue cycle operations and professional growth opportunities.
• Training and ongoing development in billing, coding, and payer systems.
• Collaborative work environment focused on performance improvement and operational excellence.
• Standard benefits may include healthcare coverage, retirement plans, and paid time off (depending on eligibility).
• Stable office-based working environment with clear processes and support systems.