Claims Specialist Job Saint George area,Utah USA,Healthcare

About the role

We’re looking for a detail-oriented Claims Specialist to join our team. This role is a great fit for someone who understands healthcare claims, enjoys solving problems, and takes pride in helping members and healthcare providers navigate the claims and reimbursement process.

As a Claims Specialist, you’ll review and process medical, dental, and vision claims while helping ensure claims are handled accurately and reimbursements are completed in a timely manner. You’ll work closely with members, healthcare providers, and internal teams to research claim issues, resolve discrepancies, and provide clear information about claim and reimbursement requirements.

What you’ll do

Review and process medical, vision, and dental claims.
Maintain a clear understanding of all current plans and their benefit features.
Maintain required productivity and quality standards.
Identify process improvement opportunities.
Send and track medical record requests.
Communicate with healthcare providers and members around claim and reimbursement status and requirements.
Maintain accurate records of claims and reimbursements.
Identify and correct discrepancies in claims.
Send and track provider refund requests.
Ensure timely reimbursement for services.
Monitor claim status and follow up on outstanding claims.
Serve as a backup for clerk tasks during employee absences.
Answer questions and provide resources to different team members.
Other duties as assigned.

Qualifications

Experience in claims and/or billing
Understanding of medical terminology
Basic knowledge of healthcare concepts including network status, reference base pricing / UCR, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, and plan variations
ICD-10, CPT, HCPCS, CDT knowledge
Basic understanding of coordination of benefits
Excellent communication skills
Must be a team player yet able to work independently
Attention to detail
Ability to multi-task and prioritize
Knowledge of appeal and subrogation is preferred

Planstin’s

Employee Benefits:

12 paid holidays plus 3 weeks of paid time off to balance work and life.
Comprehensive insurance coverage including health, dental, vision, and accident plans tailored for your well-being.
Free membership for you and your dependents to Primestin Care Clinic.
Invest in your future with a 401k plan backed by a solid 4% match from us.
Free snacks and regular lunches available onsite.

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