Medical Claims Specialist

About the role

We are seeking an experienced and highly motivated Medical Claims Specialist to join our growing healthcare team. The role focuses on managing medical insurance claims, payer relations, and revenue cycle processes to maximize reimbursement.

Key responsibilities

• Review, process, and follow up on medical insurance claims submitted to insurance companies and third‑party administrators.
• Ensure claims are accurately prepared and submitted in line with payer requirements and regulatory standards.
• Monitor claim status and proactively follow up on unpaid, pending, or rejected claims.
• Analyze claim denials and implement corrective actions to maximize reimbursement and reduce future rejections.
• Coordinate with clinical, billing, coding, and finance teams to resolve claim‑related issues.
• Maintain strong relationships with insurance providers and TPAs.
• Prepare regular reports on claims performance, collections, rejection trends, and recovery opportunities.
• Support continuous improvement initiatives related to revenue cycle management and claims processes.

Required profile

• Bachelor’s degree in Healthcare Administration, Medical Sciences, Business Administration, or a related field.
• Minimum 7 years of proven experience in medical insurance claims management within hospitals, healthcare groups, insurance companies, or TPAs.
• Strong knowledge of healthcare insurance regulations, claim submission procedures, coding systems, and reimbursement methodologies.
• Experience in denial management, claims reconciliation, and revenue cycle optimization.
• Excellent analytical, communication, and problem‑solving abilities.
• Professional certifications related to healthcare insurance or revenue cycle management are a plus.

Required skills

• Proficiency in healthcare information systems.
• Microsoft Office applications.

What we offer

• Excellent professional environment.
• Opportunities for growth within a dynamic organization.