Claims Specialist

The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships.

In this job, you will:

• Maintain ongoing knowledge of program requirements
• Analyze and process claims for accuracy, eligibility, and benefits coverage
• Retain and strengthen relationships with clients and members
• Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
• Correspond to verify if the amounts are related to the claim
• Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
• Adhere to quality assurance objectives and goals
• Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising's returns from administration services
• Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
• Keep management updated on activities, issues and developments
• Document all claims decisions and communications with members in the system accurately and timely
• Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
• Special projects as assigned by management

Reports to: Program Manager

Requirements

Education/Training

• High school diploma required; Associate's or Bachelor's degree preferred
• CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred

Experience

• 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s)

Skills/Competencies

• Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry
• Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
• Well-developed time-management, organization, and prioritization skills
• Excellent analytical skills
• Customer-service orientation
• Excellent oral and written communication skills
• Knowledge of medical billing procedures
• Ability to gather data, compile information, and prepare summary reports
• Strong interpersonal and conflict resolutions skills
• Ability to work independently and as part of a team a fast-paced, multi-faceted environment
• Demonstrated persistence and attention to detail

Physical/Mental Demands:

• Remaining in a seated position
• Entering text or data into a computer
• Visual Acuity
• Talking
• Hearing
• Repetitive arm, hand, and finger motions
• Working remotely some or all of the time

Benefits

• Pay Range: $24-28.00
• Health insurance (4 different plans to choose from)
• Dental
• Vision
• Paid time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Rise Well Wellness Program
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work

About Us:

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we're committed to:

• Continuous technological improvement
• Entrepreneurial attitude
• Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's really important, and keeping a sense of humor
• Responding quickly to client needs
• Being the best, not the biggest

Qualification

High School or equivalent