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Title

Claims Specialist  

Category Administrative  
Description

The Claims Specialist position is designed to provide support for the Claims Management Team. Responsibilities include follow up for collection of billing. Specifically, the Claims Specialist II will complete denial and outstanding balance management that allows timely collection of billed amounts

The Claims Specialist must possess excellent customer service, computer, administrative and organizational skills, be able to multi-task effectively and work well under pressure. The individual must be able to work independently, be flexible and keep projects and responsibilities prioritized. The work requires the position to be detail oriented and ensure deadlines are met. This position has access to confidential information and staff member must treat all such information with discretion. The Claims Specialist position requires the ability to exercise sound judgment, exhibit a high level of professionalism and courteousness at all times. The Claims Specialist will provider other support as needed.

Essential Job Functions:

  • Researches all outstanding balances with appropriate follow-up by the established deadline. This may include, but is not limited to, coordination with program staff regarding insurance verification, eligibility and authorizations, and communication with funding sources concerning claims denied or paid.
  • Provides ongoing root cause analysis to Claims Manager.
  • Provides feedback to Claims Manager regarding noted trends, and potential obstacles or concerns regarding payments.
  • Supports Claims Manager as needed to include analytical reporting and special assignments
  • Support programs in managing the Unbilled and Violations.
  • Other administrative projects and tasks as assigned
 
Position Requirements
  • Minimum High School Diploma or GED equivalence
  • At least one year’s experience with Medicaid, Medicare, Private Insurance and Manage Care Organization (MCO) proficient in interpreting Explanation of Benefits (EOB)
  • Strong knowledge of Microsoft Office Word, Excel, and Outlook
 
Full-Time/Part-Time Full-Time  
Shift -not applicable-  
Position Claims Specialist  
Division Administration  
Exempt/Non-Exempt Exempt  
Location Administration Raleigh  
About the Organization Easterseals UCP has been part of the fabric of North Carolina and Virginia for 75 years. We started in counties all over NC and VA filling gaps and addressing the needs of children and adults with disabilities. Our legacy organizations Easterseals NC, United Cerebral Palsy NC, and Easterseals Virginia joined forces as Easterseals UCP to intentionally work side-by-side with more than 20,000 individuals and their families, providing the broad network of services and support they need to achieve better days. Today we are affiliated with both Easterseals, Inc. and United Cerebral Palsy Inc.

Our mission is to create opportunities, promote individual choice, and change the lives of children and adults with disabilities by maximizing their individual potential to live, learn, work and play in their communities.
 
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
SuperVFlg None Specified 

HoursPerWk None Specified 

This position is currently accepting applications.

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