Medical Insurance Claims Specialist

Job Description

Job Description

We are looking for a Medical Insurance Claims Specialist to join a growing revenue cycle team in Durham, North Carolina. This contract-to-permanent opportunity is ideal for someone who thrives in a complex claims environment, can work independently, and is motivated to resolve payer-related issues with persistence and sound judgment. The role supports specialized insurance and billing operations, requiring close attention to payer guidelines, regional differences, and accurate claim follow-up. This position offers strong training, career growth potential, and a hybrid schedule with onsite work Monday through Wednesday.

Responsibilities:
• Manage medical insurance claims across an assigned group of states, taking ownership of payer follow-up and resolution activities within your region.
• Review and address claim issues by interpreting payer requirements, identifying coverage or billing discrepancies, and pursuing appropriate next steps for reimbursement.
• Verify patient and insurance eligibility details to support accurate claim submission and reduce avoidable denials.
• Post payments and reconcile billing activity while maintaining accuracy in documentation and account updates.
• Communicate with insurance carriers to clarify claim status, provide needed education on specialized services, and advocate for proper claim handling.
• Partner with billing and collections team members, supervisors, and managers to resolve complex accounts and improve reimbursement outcomes.
• Maintain organized records of claim actions, payer responses, and follow-up efforts in accordance with internal standards.
• Contribute to a high-accountability team environment by managing daily work consistently, meeting attendance expectations, and taking full ownership of assigned responsibilities.• Experience working with medical claims, insurance claims, or medical billing in a healthcare revenue cycle setting.
• Knowledge of patient eligibility verification and insurance eligibility processes.
• Ability to navigate complex payer guidelines and adjust approach based on state-specific or payer-specific requirements.
• Strong problem-solving skills with the initiative to investigate difficult claim scenarios and pursue resolution independently.
• Dependable work habits, including consistent attendance, punctuality, and the ability to manage a full workday effectively.
• Comfort working in a specialized, fast-paced environment where priorities may shift and teamwork is essential.
• Clear communication skills for interacting with payers and collaborating across billing, insurance, and collections functions.