Claim Specialist

Claim Specialist True Behavioral Health LP Irvine, CA Job Details Full-time $27 - $30 an hour 1 day ago Qualifications Record keeping Microsoft Outlook Fraud investigation Customer service Regulatory compliance in claims processing Mid-level Analysis skills Workers' compensation claims Insurance investigations Claims documentation management Medical claim denial management 2 years Documentation review Technical Proficiency Time management Behavioral health Full Job 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.