Claims Specialist

About the role

The Claim Specialist is responsible for the processing and indexing of all claim-related documentation-paper and electronic. This includes managing incoming mail, scanning and submitting claims, processing refunds, and ensuring all documentation is properly handled and recorded. The ideal candidate will have strong knowledge of medical billing, collections, insurance regulations, and oncology-specific reimbursement processes. Collaboration with patients, providers, and insurance carriers is key to achieving performance goals and client satisfaction.

Key Responsibilities

• Submit electronic and paper claims daily (primary, secondary, tertiary) in compliance with payer guidelines.
• Verify claim accuracy using billing/claim reports prior to submission.
• Identify and resolve electronic claim filing issues; escalate unresolved issues.
• Handle incoming mail: sort, scan, and route high-priority items promptly.
• Prepare and send checks, EOBs, and refund letters to designated lockboxes or recipients.
• Manage monthly scanning and mailing of refund checks with appropriate documentation.
• Import and index posted items in Focus daily.
• Maintain timely and accurate processing of zeropays, cash postings, and refunds.
• Support various administrative projects assigned.
• Qualifications
• Solid understanding of medical office procedures, terminology, and insurance claim processes.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Strong communication and interpersonal skills.
• High level of organization with the ability to prioritize tasks and manage time effectively.
• Self-driven, adaptable, and capable of working independently.
• Experience in a medical office or billing environment preferred.
• Familiarity with paper claim filing and payer-specific submission requirements.
• Ability to meet tight deadlines and manage workload under pressure.