What are the responsibilities and job description for the Claims Specialist position at Winston Staffing?
Claims Adjustment Specialist- (Medical - Hospital - Billing)
About the Role :
We seeking a highly motivated and results-oriented Claims Specialist to join the Clinical Studies & review team. In this critical role, you will be responsible for ensuring the timely and accurate resolution of claims while providing exceptional customer service. Third party claims review & analysis. Contract Temporary Role- Possible Temporary to Hire Oppty.
Key Responsibilities :
- Drive successful claim resolutions :
- Independently manage the entire appeal / dispute adjudication process, achieving high rates of successful claim resolutions within established timelines.
- Proactively identify and resolve complex claim issues, minimizing the need for escalations.
- Effectively communicate claim status and resolutions to all stakeholders, ensuring clear and timely updates.
- Demonstrate exceptional customer service :
- Build and maintain strong relationships with clients, providers, and internal stakeholders.
- Respond promptly and professionally to all inquiries, exceeding customer expectations.
- Actively seek feedback from clients and use it to continuously improve the claims process.
- Ensure operational efficiency :
- Accurately track and manage claim data, ensuring data integrity and compliance with all relevant regulations.
- Identify and implement process improvements to streamline workflows and increase efficiency.
- Proactively identify and mitigate potential risks and challenges.
- Contribute to team success :
- Actively participate in team meetings and contribute constructively to team goals.
- Mentor and train new team members, ensuring knowledge transfer and skill development.
- Foster a positive and collaborative team environment.
Qualifications :
To Apply :
