Claims Specialist - Winston Staffing : Job Details

Claims Adjustment Specialist- (Medical - Hospital - Billing)

About the Role:

We seeking a highly motivated and results-oriented Claims Specialist to join the Clinical Studies & review team. In this critical role, you will be responsible for ensuring the timely and accurate resolution of claims while providing exceptional customer service. Third party claims review & analysis. Contract Temporary Role- Possible Temporary to Hire Oppty.

Key Responsibilities:

• Drive successful claim resolutions:
• Independently manage the entire appeal/dispute adjudication process, achieving high rates of successful claim resolutions within established timelines.
• Proactively identify and resolve complex claim issues, minimizing the need for escalations.
• Effectively communicate claim status and resolutions to all stakeholders, ensuring clear and timely updates.
• Demonstrate exceptional customer service:
• Build and maintain strong relationships with clients, providers, and internal stakeholders.
• Respond promptly and professionally to all inquiries, exceeding customer expectations.
• Actively seek feedback from clients and use it to continuously improve the claims process.
• Ensure operational efficiency:
• Accurately track and manage claim data, ensuring data integrity and compliance with all relevant regulations.
• Identify and implement process improvements to streamline workflows and increase efficiency.
• Proactively identify and mitigate potential risks and challenges.
• Contribute to team success:
• Actively participate in team meetings and contribute constructively to team goals.
• Mentor and train new team members, ensuring knowledge transfer and skill development.
• Foster a positive and collaborative team environment.

Qualifications:

• Bachelor's or advanced degree in Healthcare, Business, Management, Digital Studies, or a related field.
• Minimum 2 years of experience in claims processing, customer service, or a related field within the healthcare industry. Billing & Claims adjudication experience.
• Proven ability to consistently meet deadlines and achieve performance targets.
• Demonstrated ability to work independently and as part of a high-performing team.
• Excellent written and verbal communication and interpersonal skills.
• Strong analytical and problem-solving skills with the ability to identify and resolve complex issues.
• Proficiency in Microsoft Office Suite and relevant claims processing software.
• Strong attention to detail and accuracy with a focus on quality.
• Ability to adapt to changing priorities and thrive in a fast-paced environment.

To Apply:

• Apply button below to submit your resume.