Claims Specialist

Medical Claims Specialist II (COB & Medicare Coordination)

Remote Work

Pay: $20/hr

5-Month Contract

We are seeking an experienced Medical Claims Specialist II with strong knowledge of medical claims processing and Coordination of Benefits (COB). The ideal candidate will have experience determining the correct order of payment between Medicare and commercial insurance plans, researching claim discrepancies, and resolving payment issues while maintaining compliance with healthcare regulations.

Apply today if you have medical claims processing experience and a strong understanding of Coordination of Benefits (COB) and Medicare payment rules.

Ideal Candidate

We're looking for someone who has hands-on experience reviewing medical claims, applying COB rules, identifying primary versus secondary coverage, and working with Medicare and commercial insurance carriers to ensure accurate claim payments and recoveries.

Responsibilities

• Process and review medical claims accurately and efficiently


• Determine primary and secondary insurance coverage using COB guidelines


• Research and resolve claim edits, denials, and payment discrepancies


• Analyze and adjust previously processed claims as needed


• Initiate recovery and refund processes for overpaid claims


• Review and update COB records based on Medicare and commercial carrier rules


• Communicate with members, providers, and insurance carriers to verify coverage information


• Maintain accurate claim documentation and records


• Ensure compliance with HIPAA, regulatory requirements, and company policies


• Assist with special projects, audits, and process improvement initiatives

Required Qualifications

• Medical claims processing and knowledge of how to determine primacy (order of payment) with Medicare and other commercial carriers.”


• High School Diploma or equivalent


• Minimum 2 years of medical claims processing experience


• Experience determining insurance primacy and order of payment


• Knowledge of Medicare and commercial insurance coordination rules


• Strong analytical, investigative, and problem-solving skills


• Excellent written and verbal communication abilities


• Proficiency with claims processing systems and Microsoft Office applications


• Ability to manage multiple priorities in a fast-paced environment

Preferred Qualifications

• Coordination of Benefits (COB) processing experience


• Experience adjusting claims and recovering overpayments


• Healthcare payer or health insurance industry experience

Pay & Assignment Details

• Pay Rate: $20.00 per hour


• Duration: 5-Month Contract


• Schedule: Full-Time


• Location: Fully Remote

Eligible States

Candidates must reside in one of the following approved states:

Alabama, Arkansas, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, New Hampshire, Nebraska, North Carolina, Oklahoma, Pennsylvania (excluding Allegheny, Bucks, Chester, Delaware, Montgomery, and Philadelphia counties), South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, or West Virginia.

Ideal Candidate

We're looking for someone who has hands-on experience reviewing medical claims, applying COB rules, identifying primary versus secondary coverage, and working with Medicare and commercial insurance carriers to ensure accurate claim payments and recoveries.