Job Description
Job Description
Job Title: Claims Specialist (Medical Claims)
Location: Boise, ID (Onsite)
Duration: Contract
Job Description
We are seeking a detail-oriented Claims Specialist to support medical claims processing operations. The ideal candidate will have experience reviewing and processing medical claims, a strong understanding of CMS-1500 and UB-04 claim forms, and the ability to communicate professionally with healthcare providers and claimants.
Key Responsibilities
- Scan, index, and accurately log medical bills and supporting documents into the claims management system (IRIS).
- Review CMS-1500 (Professional Claim Forms) and UB-04 (Institutional Claim Forms) for completeness and accuracy.
- Verify claim information, identify missing documentation, and contact medical providers to obtain required records.
- Interpret Explanation of Benefits (EOBs) and supporting medical documentation to assist with claims processing.
- Route completed claims to Claims Examiners for adjudication and payment.
- Maintain accurate electronic records while ensuring confidentiality of sensitive information.
- Respond professionally to inquiries from healthcare providers, claimants, and internal staff via phone and email.
- Follow established claims processing procedures and meet productivity and quality standards.
Required Qualifications
- Experience in medical claims processing, medical billing, or healthcare revenue cycle operations.
- Strong working knowledge of CMS-1500 (HCFA) and UB-04 medical claim forms.
- Ability to read and interpret Explanation of Benefits (EOBs), medical records, and insurance documentation.
- Familiarity with ICD-10, CPT, and HCPCS coding is a plus.
- Excellent attention to detail with strong data entry and organizational skills.
- Proficiency using claims management systems and Microsoft Office applications.
- Strong verbal and written communication skills with the ability to interact professionally with healthcare providers and clients.
- Ability to handle confidential information in compliance with privacy regulations.
- Ability to prioritize workload and work independently in a fast-paced environment.
Preferred Qualifications
- Prior experience in medical billing, claims adjudication, insurance operations, or healthcare administration.
- Experience working with provider billing, insurance reimbursement, or state healthcare programs.
- Familiarity with electronic medical records (EMR/EHR) and healthcare claims systems.
Note: All selected candidates must successfully pass the State of Idaho Background Check due to the confidential nature of the information handled in this role.
Company DescriptionThis position is for one of the big technology giant.
Company Description
This position is for one of the big technology giant.