Role OverviewWe are searching for a Claims Benefits Specialist who works well in a fast-paced setting. In this position, you will investigate and accurately process claim appeals within the regulatory requirements mandated by the State of Texas.
What You Will Do
Process Specialists Adjustments, Replacements, Refunds, and Appeals Queues, Review and process pended claims, Respond to internal inquiries, Ensure Special Projects are completed accurately, Participate in system testing and reviews, Identify and communicate trends related to appeals processing, Collaborate with Provider Relations team, Analyze potential system configuration setup issues, Investigate and research Texas Medicaid regulatory requirements, Utilize expertise with federal NCCI edits, MUE edits, etc.
Why It Might Be a Fit
HS Diploma Or GED Required, 3 Years Claims Processing Experience Required, A Bachelor’s degree may substitute for the required experience
Requirements
- HS Diploma Or GED
- 3 Years Claims Processing Experience
- Bachelor’s degree may substitute for the required experience
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