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Denials Specialist
Career Insights for Claims Adjuster / Specialist (General)
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Based on Texas data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$70,991 / year median in Texas
+10% projected growth
Job Description
Job Title:
Denials Specialist Location:
Houston, TX (Downtown)
Industry:
Healthcare /
Revenue Cycle Management Pay:
$26 - $28 / hr
Job Type:
Direct Hire Benefits:
This position is eligible for medical, dental, vision, and 401k.
About Our Client:
Addison Group is partnering with a professional services organization seeking an experienced Denials Specialist with strong hospital billing expertise. This role is ideal for a high-level collector who understands complex technical claims, payor guidelines, and regulatory requirements including NSA and out-of-network billing. The Denials Specialist will manage hospital UB-04 claims from follow-up through resolution, with a heavy focus on denial management. This position requires advanced knowledge of commercial payors, strong analytical skills, and experience navigating complex reimbursement issues involving out-of-network and regulatory considerations.
Key Responsibilities:
Review and resolve denials related to hospital (UB-04) claims. Conduct detailed payor follow-up with major commercial insurance carriers. Investigate technical claim issues and determine appropriate next steps for resolution. Manage both denials and appeals, with a primary focus on denial recovery. Handle NSA (No Surprises Act) and out-of-network (OON) collections and dispute processes. Analyze claim adjudication trends and identify patterns in payor behavior. Ensure proper documentation and compliance throughout the resolution process. Work independently while maintaining communication with internal stakeholders.
Requirements:
5+ years of hospital claims experience required. Strong background working with UB-04 claims. Extensive experience managing denials (more denial-focused than appeals). Experience with NSA and out-of-network (OON) collections required. Heavy commercial payor experience strongly preferred. High-level collector with strong analytical and problem-solving skills. Ability to interpret complex EOBs and technical claim data.
Additional Details:
Schedule:
Monday-Friday, 8:00am-5:00pm (flexibility for 7:30am-4:00pm if needed)
Assignment Type:
Direct Hire Work Model:
Fully onsite
Environment:
Professional office setting
Dress Code:
Business casual Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request. #HC3