Claims Specialist

Role overview

The Claims Specialist oversees the full claims lifecycle for diagnostic laboratory services. The position focuses on accurate and prompt claim preparation, submission, tracking, and resolution with insurers to help improve reimbursement outcomes, limit claim denials, and protect the lab’s revenue performance.

Key responsibilities

• Prepare, validate, and send claims for diagnostic lab services to both commercial and government insurance payers while following payer rules and internal laboratory policies.
• Review denied claims, determine why they were rejected, and take corrective steps such as appeals or corrected resubmissions.
• Monitor open claims, work aging reports, and contact payers to remove blockers and accelerate payment.
• Keep detailed records of claim progress, payer correspondence, and responses inside the billing platform.
• Partner with prior authorization, billing, and reimbursement teams to resolve more complex claim issues and support broader revenue cycle efforts.
• Stay up to date on payer policies, laboratory coding changes such as CPT and ICD-10, and regulatory updates that affect claim processing.
• Create and review claims performance reports to spot trends, recommend improvements, and help leadership make informed decisions.

Experience and qualifications

• An associate degree or bachelor’s degree in healthcare administration, business, or a related discipline is preferred.
• At least 2 years of experience handling medical claims, ideally in a diagnostic laboratory or healthcare environment.
• Solid understanding of insurance billing, payer expectations, and denial resolution practices.
• Working knowledge of lab-related coding, including CPT and ICD-10, plus familiarity with EOBs and remittance advice.
• Comfort using billing systems and Microsoft Office applications.
• Strong detail orientation, organization, and written and verbal communication skills.
• Ability to work both independently and as part of a team in a fast-paced setting.

Work environment

This is a fully remote role. The employee will work from a home office or another suitable remote location with reliable high-speed internet. The work setting is climate-controlled and uses standard office tools such as a computer, telephone, and video conferencing software. The regular schedule and working hours will be set together with the manager and may change as business needs evolve.

Physical requirements

• Extended sitting, for as much as 8 hours per day.
• Frequent use of hands and fingers for typing and mouse use.
• Good visual focus for reading screens and documents.
• Ability to communicate effectively by phone and video.
• Occasional lifting of items weighing up to 10 pounds, such as office supplies or equipment.

Additional notes

Reasonable accommodations may be provided to support individuals with disabilities in performing the essential duties of the role.

This job summary is not exhaustive. Team members may be asked to carry out other related duties or instructions assigned by their supervisor.

Compensation

The budgeted pay range is USD 34 to USD 37 per hour.

About the company

GeneDx is a science-driven organization focused on improving patient outcomes through advanced genetics and genomic testing. With more than 20 years of experience in diagnosing rare disorders and diseases, the company combines scientific expertise, clinical knowledge, and research innovation to deliver clear, reliable answers for patients and healthcare providers.

The company emphasizes urgency, strong collaboration, ownership, and high standards. Employees are encouraged to act decisively, think beyond the obvious, and keep learning in a fast-moving environment where meaningful impact matters.

Benefits

• Paid time off.
• Health, dental, vision, and life insurance.
• 401(k) retirement savings plan.
• Employee stock purchase plan.
• Employee discounts.
• Voluntary benefits.
• Support programs for parents and expectant parents.
• Family-planning, pregnancy, and postpartum support, including up to 22 weeks of fully paid parental leave in the U.S. and up to $25,000 per year for fertility, adoption, or surrogacy assistance.

Equal opportunity

GeneDx is an equal opportunity employer.