Medical Claims Specialist

Medical Claims Specialist Real Soft, Inc. - 4.0 Minneapolis, MN Job Details Contract Up to $28.16 an hour 1 day ago Qualifications Benefits administration Microsoft Outlook Spreadsheets Medical coding Medical coding guidelines Medical claims processing software Health insurance knowledge Problem-solving Customer engagement Insurance policy review Disability determination Critical thinking Medical terminology Documentation review

Full Job Description Job Title:

Medical Claims Specialist Location:

Minneapolis, MN (Hybrid - 2 Days/Week Onsite)

Employment Type:

Contract-to-Hire Job Summary Seeking an experienced Critical Illness Claims Analyst to interpret policy language, review complex medical documentation, and adjudicate critical illness insurance claims accurately and efficiently. The ideal candidate will provide exceptional customer service while ensuring compliance with regulatory requirements and internal standards. Key Responsibilities Analyze, investigate, and process complex Critical Illness claims accurately and timely. Determine claim approvals, denials, or requests for additional information based on policy provisions. Review medical records and clinical documentation to validate eligibility and benefit conditions. Communicate claim decisions clearly to customers through written correspondence and phone interactions. Handle sensitive customer situations with empathy and effective de-escalation techniques. Manage assigned work queues and meet established service level agreements (SLAs). Participate in root cause analysis and continuous process improvement initiatives. Collaborate with internal teams and cross-functional departments to resolve customer issues. Maintain compliance with company policies, regulatory requirements, and documentation standards. Support additional projects and duties as assigned. Required Qualifications Experience processing insurance claims, preferably Critical Illness or Voluntary Benefits claims. Strong medical terminology and medical record review skills. Ability to interpret diagnoses, clinical evidence, and policy language to determine benefit eligibility. Experience handling complex claims and customer communications. Excellent analytical, critical thinking, and problem-solving abilities. Strong written and verbal communication skills. Ability to prioritize workloads and manage multiple tasks effectively. Advanced proficiency in claims processing systems and navigating multiple applications simultaneously. Strong knowledge of Microsoft Excel, Word, and Outlook. Ability to work independently with minimal supervision while maintaining high-quality standards. Preferred Qualifications Voluntary Critical Illness Insurance claims experience. Complex medical review and adjudication experience. Background in insurance, healthcare, disability, or benefits administration.

Pay:

Up to $28.16 per hour

Experience:

Medical coding: 1 year (Required)

Medical Claims:

4 years (Required)

Medical Insurance:

2 years (Required)

Work Location:

Hybrid remote in Minneapolis, MN 55401