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Medical Claims Specialist - Remote at Rising Medical Solutions. The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships. . In this job, you will: . . Maintain ongoing knowledge of program requirements. . Analyze and process claims for accuracy, eligibility, and benefits coverage. . Retain and strengthen relationships with clients and members. . Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary. . Correspond to verify if the amounts are related to the claim. . Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems. . Adhere to quality assurance objectives and goals. . Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services. . Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments. . Keep management updated on activities, issues and developments. . Document all claims decisions and communications with members in the system accurately and timely. . Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies. . Special projects as assigned by management. . Reports to: . Program Manager. Education/Training. . High school diploma required; Associate’s or Bachelor’s degree preferred. . CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred. . Experience. 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s). Skills/Competencies. . Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry. . Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices . . Well-developed time-management, organization, and prioritization skills . . Excellent analytical skills . . Customer-service orientation. . Excellent oral and written communication skills. . Knowledge of medical billing procedures. . Ability to gather data, compile information, and prepare summary reports. . Strong interpersonal and conflict resolutions skills. . Ability to work independently and as part of a team a fast-paced, multi-faceted environment. . Demonstrated persistence and attention to detail. . Physical/Mental Demands:. . Remaining in a seated position. . Entering text or data into a computer. . Visual Acuity. . Talking. . Hearing. . Repetitive arm, hand, and finger motions. . Working remotely some or all of the time. . Company Location: United States.