Medical Claims Specialist

Role Overview

We are seeking a remote Medical Claims Specialist for a 4–5 month contract assignment. The role supports claims operations by reviewing grievance and appeal activity, assisting with customer and team questions, and helping maintain quality and workflow standards.

Key Duties

• Monitor grievance, appeal, and medical record patterns and share notable trends with management.
• Support the Claims Department in handling customer questions.
• Help answer questions and provide guidance or training support for Level 1 Reviewers.
• Complete focused quality-sampling audits and summarize the results for management.
• Participate in appeals and grievance roundtable meetings when scheduled.
• Assist with the aging report workload as needed.
• Help with case assignment tasks as required.

Experience Requirements

The position calls for at least 1 year of experience in claims processing, medical or pharmacy precertification, appeals and grievances coordination, or a closely related function. Preferred backgrounds include leadership experience in claims, work across multiple claims systems, and experience in medical or healthcare settings.

Preferred Background

• 2 years in a lead or senior claims position.
• 3 years working in claims processing and correspondence using multiple claims systems.
• 2 years of experience in the medical or healthcare field.
• 3 years of experience as a pharmacy technician or precertification technician.
• Certified Coder certification is preferred.

Compensation and Notices

The pay range for this role is $15.00 to $19.00 per hour. Information about benefits, equal opportunity employment, and location-specific applicant notices is available through the employer's standard notice materials. The organization states its commitment to fair compensation and wage transparency in line with applicable state and local laws.