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Claims Specialist - 257439

Claims Specialist - 257439

medixScottsdale, AZ

3 days ago

$22–$24/Hour

Claims Adjusters, Examiners, and InvestigatorsInsurance Claims and Policy Processing ClerksBilling and Posting Clerks
Claims AdjustingAll Other Insurance Related ActivitiesAll Other Miscellaneous Ambulatory Health Care Services
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Claims Specialist – Out-of-Network ClaimsRemote – Must Reside Arizona | $22–$24/Hour | Out-of-Network Experience REQUIREDMUST HAVE OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCERemote – Arizona Residents Only$22–$24/hour Equipment Provided Monday–Friday Monthly Bonus Potential
About the Role: We are seeking an experienced Claims Specialist with a strong background in OUT-OF-NETWORK BILLING AND CLAIMS to join a collaborative team specializing in air ambulance claims, member appeals, and insurance reimbursement. Out-of-network claims experience is a hard requirement for this position. Candidates must have hands-on experience working with out-of-network insurance claims and reimbursement. This is not a role where out-of-network billing can be learned from scratch. Air ambulance experience is a plus, but extensive training will be provided on the specific air ambulance processes. What we need you to already bring is a strong foundation in out-of-network claims, medical A/R, collections, and revenue cycle management. This is a detail-oriented role for someone who enjoys investigating complex claims, communicating with insurance companies and patients, and finding solutions rather than simply processing claims.
Key Responsibilities:
  • Manage approximately 25–30 insurance claims per day
  • Work extensively with OUT-OF-NETWORK CLAIMS and reimbursement
  • Research complex claim issues and determine appropriate resolution
  • Navigate commercial insurance requirements and out-of-network reimbursement processes
  • Perform eligibility and benefits verification
  • Apply air ambulance-specific eligibility and reimbursement criteria
  • Investigate and process member appeals
  • Gather and submit prior authorizations, medical records, and supporting documentation
  • Communicate with patients, families, employers, and insurance providers by phone, email, and online chat
  • Follow up with insurance companies regarding claim status, reimbursement, and outstanding issues
  • Maintain detailed and accurate claim documentation
  • Track productivity and quality metrics
  • Collaborate with the team and escalate complex issues appropriately
  • Proactively identify problems and ask questions when additional support is needed
Required Qualifications:
  • OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCE — REQUIRED2+ years of A/R and collections experience
  • Hands-on experience with OUT-OF-NETWORK medical billing/claims — REQUIREDExperience working with commercial insurance
  • Strong understanding of insurance claims and reimbursement processes
  • Strong critical-thinking and problem-solving abilities
  • Excellent verbal and written communication skills
  • Strong attention to detail
  • Ability to investigate complex claims rather than simply follow a repetitive workflow
  • Comfortable working across multiple systems and researching claim information
  • Adaptable, inquisitive, and willing to ask questions and escalate issues appropriately
  • Ability to work independently while contributing to a collaborative team
  • Preferred Experience
  • Air ambulance billing or claims
  • Hospital billing / RCMCritical care billing
  • Single-specialty healthcare billing
  • Medical collections
  • Member appeals
  • Prior authorization
Medical record requests?? Important Candidate RequirementOUT-OF-NETWORK CLAIMS EXPERIENCE IS A MUST-HAVE.We are specifically looking for candidates who have personally worked on out-of-network billing/claims and understand the challenges of obtaining reimbursement from commercial insurance plans. Candidates with only in-network billing experience will not be considered for this position. Air ambulance experience is preferred but not required — we will train the right candidate on the air ambulance-specific aspects of the role. Training & Schedule Initial Training: Approximately 90 days Monday–Friday, 6:00 AM–3:00 PM Arizona time8-hour shift with a 30-minute lunch Fully virtual training through Microsoft Teams Interactive training with screen sharing and ongoing support Post-Training: Monday–Friday Flexible start time between 6:00 AM–8:00 AM Arizona time Consistent start time once selected Remote WorkRemote – Arizona Must reside in Arizona Approximately 1 onsite day per month at the North Scottsdale office Equipment must be picked up in person on the first day Company provides: Laptop MonitorKeyboardMouseHeadsetMust have a reliable internet connection and HIPAA-compliant workspace

Also on the board Same function, level within a rung

Level

Senior

Salary

$22–$24/Hour

Location

Scottsdale, AZ

Occupation

Claims Adjusters, Examiners, and Investigators

Industry

Claims Adjusting

Posted

3 days ago

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