Claims Specialist - Remote

The Claims Specialist at RISING Medical Solutions is responsible for reviewing, processing, and coordinating claims accurately in line with program guidelines. This role involves maintaining knowledge of program requirements, analyzing claims for accuracy, communicating with clients and members, and resolving reimbursement issues related to medical services.

To qualify for the Claims Specialist position at RISING Medical Solutions, you need at least a high school diploma, while an Associate’s or Bachelor’s degree is preferred. Medical coding certifications like CPC or CCS are also advantageous. Experience of 2-4 years in insurance or healthcare, especially in claims or medical billing is highly valued.

Essential skills for a Claims Specialist at RISING Medical Solutions include a strong knowledge of medical terminology, CPT and ICD coding, excellent analytical and organizational abilities, as well as a customer-service orientation. Additionally, strong communication skills and the capacity to work both independently and as part of a team in a fast-paced environment are critical.

As a Claims Specialist at RISING Medical Solutions, you will primarily work remotely, allowing for a flexible work-life balance. The role may involve sitting for extended periods and requires visual acuity and repetitive hand motions for data entry, making a home-office setup essential for productivity.

RISING Medical Solutions provides a comprehensive benefits package for its Claims Specialists, including multiple health insurance options, dental and vision coverage, paid time off, a 401(k) plan, life insurance, disability insurance, and a wellness program. They also support professional growth through a development reimbursement program.

When answering this question, highlight specific experiences, mentioning the types of claims you have processed. Discuss any software tools you’ve used and demonstrate your understanding of medical billing and coding terminology.

Discuss your attention to detail and the steps you take to review claims thoroughly. Mention strategies for double-checking information and following up to confirm accuracy with necessary stakeholders.

Share your methods for prioritizing tasks and staying organized, such as using tools or systems to track claims by deadlines. Highlight any specific experiences where effective time management led to successful outcomes.

Use the STAR method (Situation, Task, Action, Result) to articulate a challenging situation regarding a claim and how you worked systematically to resolve it, emphasizing your communication and problem-solving skills.

Talk about the importance of empathetic communication and listening carefully to clients’ concerns. Describe a scenario where you turned a dissatisfied client into a satisfied one through your proactive approach to resolution.

Demonstrate your knowledge of relevant laws and regulations impacting claims processing. Discuss the importance of adhering to these regulations and how your past experiences have prepared you to maintain compliance.

Describe any certifications like CPC or CCS that you possess, explaining how they enhance your understanding of medical coding and billing practices relevant to the Claims Specialist role.

Share a specific example illustrating how you contributed to a team's success. Emphasize effective communication, the sharing of knowledge, and how collaboration led to positive outcomes.

Identify a common challenge, such as handling a high volume of claims or addressing complex discrepancies, and explain how you would approach these challenges, drawing on past experiences.

Express your alignment with RISING Medical Solutions’ values, and discuss how your skills and experiences make you a good fit for the position, highlighting your passion for client relationships and problem-solving in the healthcare domain.