Claims Specialist II, Medical Claims and Coordination of Benefits
Employment type
Full-time
Work setting
On-site
Location
Baton Rouge, LA
Schedule
Day shift
Posted
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Job overview
The Claims Specialist II, Medical Claims and Coordination of Benefits role is listed in Baton Rouge, LA; the posting does not specify whether the work is onsite, hybrid, or remote. Compensation is not specified. The role joins a healthcare claims operations team to investigate and resolve medical claims issues.
What you'll do
- Review, research, and process medical claims
- investigate edits, denial and processing codes, and payment discrepancies
- adjust and reprocess claims
- recalculate benefits
- research Coordination of Benefits and determine primary versus secondary coverage
- correct coverage records
- communicate with members, providers, and insurers
- identify overpayments and initiate recovery
- review audit findings, maintain documentation, and partner with other departments on complex issues and process improvements.
What we're looking for
- Skills & competencies
- claims specialist iimedical claimscoordination of benefitsclaims processingclaims researchpayment adjustmentsoverpayment recoverybaton rouge latier4 grouphealthcare operationshigh school diploma2+ years claims experience
- Work arrangement
- Weekend coverage required
Why this role
Requires at least two years of hands-on medical claims processing experience and a high school diploma or equivalent. Coordination of Benefits experience is highly preferred.
About the employer
Tier4 Group is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
- Occupation code
- 13-1031.00
You'll be redirected to the employer's application page.
Listing ID: 3b5243e5-797e-42d2-be2f-42d4a0dfd8f5