Full-Time Claims Specialist
Healthaxis is hiring a remote Full-Time Claims Specialist. The career level for this job opening is Experienced and is accepting USA based applicants remotely. Read complete job description before applying.
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Healthaxis
Job Title
Claims Specialist
Posted
Career Level
Full-Time
Career Level
Experienced
Locations Accepted
USA
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Job Details
PURPOSE AND SCOPE:
The Claims Specialist serves Medicare insurance customers by determining insurance coverage, examining and resolving Medical claims, documenting actions, maintaining quality customer services, ensuring legal compliance.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
- Responsible for processing claims in accordance with production, timeliness and quality standards.
- Participates with other health plan departments in the resolution of claims issues across department lines.
- Ensures claims are processed in compliance with governmental and accrediting agency regulations.
- Ensures the delivery of superior customer service by providing timely and accurate claims payment and responding timely to member and provider inquiries and complaints regarding claims processing.
- Develops strong intradepartmental relationships with other department personnel and/or exempt individual contributors to ensure clear communication and prompt resolution to issues.
- Follows departmental policies and procedures regarding claims adjudication.
- Ensures that potential fraudulent claims practices are identified and reported to the appropriate compliance department.
- Follows all HIPAA compliance guidelines to ensure protection of member protected health information.
- Responsible for driving the HealthAxis culture through values and customer service standards.
- Accountable for outstanding customer service to all external and internal contacts.
- Develops and maintains positive relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
EDUCATION, EXPERIENCE AND REQUIRED SKILLS:
- Understanding of hospital and/or physicians’ contracts to determine payable benefits and knowledge of pricing DRG, APC and per diem for all Medical claim products.
- Excellent oral and written communication skills including good grammar, voice and diction.
- Able to read and interpret documents and calculate figures and amounts.
- Proficient in MS Office with basic computer and keyboarding skills.
- Excellent customer service skills (friendly, courteous and helpful).
EDUCATION:
- High school diploma or general education degree (GED) required.
- Minimum two years’ experience in managed care claims processing environment required.
- Experience with the internal configuration of claim processing systems and the links between contracts, utilization management and claims processing within these systems required.
- An equivalent combination of education, training, and experience.
FAQs
What is the last date for applying to the job?
The deadline to apply for Full-Time Claims Specialist at Healthaxis is
2nd of December 2025
. We consider jobs older than one month to have expired.
Which countries are accepted for this remote job?
This job accepts [
USA
] applicants. .
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