Claims Specialist

The Medical AR and Denial Management Specialist is responsible for ensuring timely and accurate handling of medical claims. This role focuses on insurance follow-ups, resolving denials, and identifying insights that support process improvement. The specialist ensures compliance with healthcare regulations while maintaining excellent communication, precise documentation, and efficient claims resolution to enhance overall revenue cycle performance.About the RoleThe Medical AR and Denial Management Specialist is responsible for ensuring timely and accurate handling of medical claims. This role focuses on insurance follow-ups, resolving denials, and identifying insights that support process improvement.ResponsibilitiesOutbound Calling Conduct outbound calls to insurance companies and payors to obtain claim statuses, denial reasons, and other required information.Ensure all calls comply with client guidelines and healthcare regulations.Maintain professionalism and clear communication at all times.Data Categorization & Labeling Record, categorize, and label all information accurately using the client’s taxonomy and definitions.Ensure consistent labeling of claim statuses and call outcomes for proper reporting and analysis.Submit categorized data through scheduled reports or through the client’s portal as required.Call Transcript Analysis Review call transcripts to identify insights, trends, and recurring denial reasons.Compile findings into periodic reports to support process improvement and workflow optimization.QualificationsMinimum of 6 months’ experience in medical billing, insurance claims, or a related field.Strong English communication skills, both verbal and written.Familiarity with healthcare regulations and industry guidelines.Comfortable making outbound calls to insurance companies and payors.Highly detail-oriented with strong record-keeping skills.Ability to work independently while following internal procedures.Proficiency in Microsoft Office or similar tools; experience with medical billing software is an advantage. Required SkillsStrong English communication skills, both verbal and written.Familiarity with healthcare regulations and industry guidelines.Comfortable making outbound calls to insurance companies and payors.Highly detail-oriented with strong record-keeping skills.Ability to work independently while following internal procedures.Proficiency in Microsoft Office or similar tools; experience with medical billing software is an advantage.Preferred SkillsExperience with medical billing software is an advantage.```