
Customer Claim Resolutions Specialist
2 weeks ago
This role is for a specialist in resolving outstanding claims for US healthcare customers through calling.
The ideal candidate will have excellent communication skills, a willingness to learn, and a commitment to accurate documentation and client service.
Responsibilities:- Perform pre-call analysis and check the status of claims by calling payers or using IVR/web portals.
- Ensure adequate documentation on client software to maintain a clear audit trail and facilitate document submission.
- Record after-call actions and conduct post-call analysis for effective claim follow-up.
- Assess and resolve inquiries, requests, and complaints via phone, aiming for first-call resolution.
- Provide accurate information by researching available documentation before making calls.
- Analyze accounts receivable data to understand reasons for underpayments and denials.
- Fluent verbal communication abilities and call center expertise.
- A basic working knowledge of computers.
- Ability to learn and adapt to new software and processes.
- Knowledge of healthcare terminology and ICD/CPT codes is an advantage.
- Willingsness to work continuously in night shifts.
- Prior experience in a medical billing company or with medical billing software is beneficial, but not required.
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Claims Resolution Expert
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Claims Specialist
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