Job summary

Job Summary:

The Claims Specialist at Assertive Insurance is responsible for reviewing, processing, and resolving health insurance claims efficiently and accurately. This role ensures that claims comply with company policies, industry regulations, and contractual obligations. The ideal candidate will have a strong understanding of health insurance policies and excellent attention to detail.

Key Responsibilities:

• Review and process health insurance claims in accordance with company guidelines.
• Verify patient information, medical codes, and policy coverage before approving or denying claims.
• Investigate discrepancies, resolve claim disputes, and coordinate with healthcare providers.
• Communicate with policyholders to explain claim decisions and answer inquiries.
• Identify fraudulent claims and escalate them for further investigation.
• Maintain accurate records of all claims and processing activities in the system.
• Ensure compliance with industry regulations and company policies.
• Collaborate with underwriters, legal teams, and customer service representatives to resolve complex cases.

Qualifications & Skills:

• Education: Bachelor’s degree in Business, Healthcare Administration, or a related field (preferred).
• Experience: 1-3 years of experience in health insurance claims processing, medical billing, or a related field.
• Skills:
  • Strong analytical and problem-solving abilities.
  • Excellent communication and customer service skills.
  • Proficiency in insurance claims software and Microsoft Office Suite.
  • Knowledge of medical terminology, CPT, and ICD coding (preferred).
  • Ability to handle a high volume of claims while maintaining accuracy.

Benefits:

• Competitive salary and performance-based bonuses.
• Health, dental, and vision insurance.
• Paid time off, holidays, and wellness programs.
• Professional training and career growth opportunities.
• A supportive and dynamic work environment.