What are the responsibilities and job description for the Claims Specialist II position at Strategic Staffing Solutions?
Job Description Job Title: Claims Specialist II Location: Remote Pay Rate: $23.00/hour Duration: Contract Opportunity Position Summary We are seeking a Claims Specialist II to support medical claims operations with a focus on Coordination of Benefits (COB). This role is responsible for researching, analyzing, and processing claims while ensuring accurate benefit calculations, claim adjustments, overpayment recovery, and compliance with applicable regulations and company policies. The ideal candidate will have experience in medical claims processing and a strong understanding of Coordination of Benefits (COB), including determining primary and secondary coverage and resolving claim discrepancies
Key Responsibilities Review, research, and process medical claims and claim adjustments. Analyze and resolve claims edits, denials, and payment discrepancies. Determine the correct order of benefits when multiple insurance plans are involved.
Maintain and update Coordination of Benefits (COB) records. Reprocess claims and initiate refund requests for overpayments as needed. Investigate and resolve complex claims issues while maintaining accurate documentation.
Communicate with members, providers, insurance carriers, and internal departments regarding claim status and coverage information. Review quality audits and make required corrections within established service levels. Support recovery efforts for overpaid claims and ensure accurate reimbursement.
Ensure compliance with HIPAA, regulatory requirements, and company policies. Assist with special projects, training initiatives, and process improvements as assigned. Required Qualifications High School Diploma or equivalent.
Minimum of 2 years of medical claims processing experience. Experience researching and resolving claim issues. Strong analytical, investigative, and problem-solving skills.
Excellent written and verbal communication skills. Proficiency with Microsoft Office and claims processing systems. Ability to manage multiple priorities in a fast-paced environment.
Preferred Qualifications Coordination of Benefits (COB) experience. Experience determining primary and secondary insurance coverage. Knowledge of Medicare coordination and COB primacy rules.
Experience with claim adjustments, overpayment recovery, and refund processing. Skills & Competencies Attention to detail Critical thinking and analysis Customer service orientation Time management and prioritization Effective communication Team collaboration
Salary : $23