Claims Specialist (Dispute Resolution)
7 days ago
Muttontown
Job DescriptionClaims Specialist (Dispute Resolution) Pay Rate: $20.00 - $25.00/hour Location: Remote Contract: 6-12 months Schedule: Monday-Friday, 8:00 AM - 5:30 PM Position Overview This role supports the resolution of medical claims disputes and appeals through end-to-end case coordination, documentation management, and cross-functional communication. The Claims Specialist acts as a key liaison between internal teams, healthcare providers, payers, and other stakeholders to ensure timely and accurate processing of appeal and dispute cases. This position is ideal for someone who is detail-oriented, comfortable working in a high-volume, deadline-driven environment, and confident managing multiple moving parts across clinical and administrative teams. Key Responsibilities • Serve as the primary point of contact for medical claims appeal and dispute resolution programs, • Coordinate communication between healthcare plans, providers, patients, clients, and internal teams, • Monitor appeal/dispute status through client portals and internal tracking systems, • Conduct initial eligibility and case reviews, escalating recommendations to internal leadership as needed, • Track, assign, and manage cases using internal workflow systems, • Compile and distribute case documentation to clinical reviewers, including coders, nurses, physicians, and other stakeholders, • Ensure timely completion of deliverables while maintaining quality and compliance standards, • Monitor key performance indicators (KPIs), including turnaround time, accuracy, and contract requirements, • Identify workflow barriers and recommend process improvements, • Participate in daily/regular team huddles and provide case status updates in an agile workflow environment, • Schedule meetings, document decisions, and track next steps/action items, • Prepare and submit billing invoices upon case completion and coordinate with finance/accounting teams, • Train and mentor new team members on processes and case progression, • Other duties as assigned Required Qualifications • Associate's or Bachelor's degree in Healthcare, Business, Management, Digital Studies, or related field, • Minimum 2 years of experience in healthcare administration, medical claims, appeals, case management, or related field, • Strong written and verbal communication skills, including professional phone etiquette, • Ability to work independently with minimal supervision, • Strong problem-solving skills and ability to collaborate across clinical and administrative teams, • Ability to manage multiple priorities in a deadline-driven environment, • Flexible, adaptable, and comfortable working in a fast-paced workflow environment Technical Skills • Experience with internal case management or workflow systems (training provided), • Proficiency with Microsoft Office Suite (Excel, Outlook, Word), • Comfortable working with electronic documentation and tracking tools Training & Onboarding • 2-4 week structured training program provided, • Training includes systems navigation, workflow processes, and case handling procedures, • Ongoing support provided during ramp-up period Preferred Qualifications • Prior experience with medical claims, appeals, utilization review, or revenue cycle operations, • Exposure to payer/provider communication workflows, • Experience working in high-volume case processing environments Additional Information • Equipment provided for remote work, • Temporary equipment deposit policy applies: $50/week deducted for 10 weeks ($500 total), fully refunded after 10 weeks upon compliance with policy, • Onboarding includes background check, drug screening, and health screening, • Business casual dress code (professional virtual environment expected), • Employment is through Medix for the duration of the assignment For California Applicants: We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA). This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients. Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine. Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?