Complex Claims Specialist

The Complex Claims Specialist is responsible for reviewing and resolving high-complexity insurance claims, including escalations, disputes, and denied cases. This role involves analyzing medical and billing data, ensuring compliance with policies, and coordinating with multiple stakeholders to achieve accurate and timely claim resolution.

Essential Responsibilities

• Claims Management : Proactively manage workers’ compensation claims by contacting insurance carriers, adjusters, and utilizing web portals to address outstanding bills.
• Claims Submission & Appeals : Prepare and submit accurate claims while verifying and correcting errors. Compile required documentation for appeals and submit promptly to carriers.
• Billing Accuracy : Update incorrect insurance and patient billing demographics while addressing related issues. Communicate trends or concerns with the team and management.
• Payment Pr...