Rightway Healthcare

About Rightway Healthcare

Medical Claims Specialist Job Description The Medical Claims Specialist serves Rightway Healthcare members by determining insurance coverage; examining and resolving medical, dental, and vision claims; spotting medical billing errors, documenting actions; maintaining high-quality customer service; and preparing appeal letters. Responsibilities Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies Initiates investigation of questionable claims Resolves medical, dental, and vision claims by examining the summary of benefits and contacting the carrier to ensure the member is not being overcharged, calculating benefits due, initiating payment from carrier to the provider or composing appeal letter Provides information on the year-to-date deductible, copay, and coinsurance to team members Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner Protects claimant information by following HIPPA guidelines Reports claim status updates in proprietary CRM and provide detailed information of each claim Skills and Qualifications Customer service skills Professional experience with claims adjustment Verbal and written communication skills Problem-solving skills Organizational skills Attention to detail Bachelor’s degree in health sciences or related field and a minimum of 3 years of experience as a medical claims specialist. Job Type: Full-time Salary: $40,000.00 to $45,000.00 /year Experience: Claims Specialist: 3 years (Required) Language: English/Spanish (Preferred) Work authorization: United States (Required) Additional Compensation: Bonuses Work Location: One location Benefits: Health insurance Dental insurance Vision insurance Retirement plan Paid time off Parental leave Schedule: Monday to Friday 8 hour shift

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