Claim Specialist at pmX Group

Irvine, California, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Aug, 26

Salary

30.0

Posted On

15 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Behavioral Health Billing, AR Resolution, Denial Management, Payer Communication, Fraud Prevention, Risk Analysis, MS Office, Guidewire, VUE, Customer Service, Time Management, Problem-Solving, Detail-Oriented, Claims Evaluation, Documentation

Industry

Description

Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ensuring timely reimbursement across commercial and workers’ compensation payers. The ideal candidate is detail-oriented, proactive, and experienced in behavioral health billing workflows, including claim corrections, payer communication, and AR resolution. Responsibilities: • Claims Processing: Review and process incoming claims for accuracy, completeness, and compliance with policies and regulations. • Claims Evaluation: Evaluate and assess the validity of claims based on established guidelines, reviewing medical records, police reports, and other relevant documentation. • Claims Payment: Coordinate with the finance department to ensure timely and accurate claims payments. • Investigation and Resolution: Investigate complex claims, including fraud prevention and risk analysis, and resolve any discrepancies or issues in a timely manner. • Documentation: Maintain detailed and accurate records of claims processed, including all correspondence and supporting documentation. • Compliance: Ensure all claims are processed in accordance with company policies, industry standards, and legal requirements. • Reporting: Provide regular reports on claims status, processing times, and claim trends to management. • Any other duties as assigned by department Minimum Requirements: • Experience: Minimum of 2-3 years of experience in claims processing or a related field. • Knowledge: Understanding of insurance policies, claims procedures, and industry regulations. Competencies: • Detail-Oriented: Ability to carefully evaluate and manage claims with a high degree of accuracy. • Problem-Solving Skills: Strong analytical and problem-solving skills to address and resolve issues in claims. • Technical Skills: Proficiency in MS Office (Word, Excel, Outlook) and claims management software (e.g., Guidewire, VUE, etc.). • Customer Service: Ability to deliver excellent customer service and resolve issues in a timely manner. • Time Management: Strong organizational and time-management skills, with the ability to handle multiple tasks efficiently.

Responsibilities

Manage insurance claims follow-up and resolve denials to ensure timely reimbursement for behavioral health services. Responsibilities include evaluating claim validity, investigating complex discrepancies, and maintaining accurate documentation of all processed claims.