Overview
The Claims Billing Specialist II is responsible for accurately processing and reconciling various financial transactions such as cash allocations, payments, and adjustments. This role ensures compliance with company policies, contractual agreements, and regulatory standards. It serves as a point of contact for escalated billing disputes and moderately complex payment issues, collaborating with internal teams, adjusters, and vendors to achieve timely resolutions. The position also supports process improvements by identifying recurring issues, maintaining thorough documentation and audit trails, and mentoring junior staff to build expertise and consistency within the team.
Responsibilities
- Process and reconcile financial transactions including cash allocations, payments, adjustments, and in-house calculations with accuracy and timeliness.
- Ensure compliance with company policies, contractual agreements, regulatory standards, and internal controls, maintaining proper documentation, audit trails, and approval workflows.
- Research, investigate, and resolve escalated billing disputes, payment discrepancies, and moderately complex financial inquiries.
- Collaborate with internal teams, adjusters, vendors, and other stakeholders to resolve financial challenges efficiently and communicate outcomes effectively.
- Identify recurring issues and recommend process improvements to enhance operational efficiency, cost containment, and customer satisfaction.
- Provide mentorship and guidance to Specialist I staff, modeling best practices in documentation, compliance, and customer service.
- Accurately document all resolution and payment activities in compliance with policies and regulatory requirements.
- Serve as a Subject Matter Expert within the department.
- Perform other duties as assigned.
Requirements
- 2–3 years of experience in medical billing, claims, or general accounting; workers’ compensation experience preferred.
- Strong knowledge of billing practices, healthcare terminology, and claims systems.
- Experience researching, calculating, and processing provider payments.
- Excellent written, verbal, listening, and interpersonal communication skills.
- Strong attention to detail with the ability to work independently with minimal supervision.
- Excellent organizational, prioritization, analytical, problem-solving, and decision-making skills.
- Ability to adapt quickly to new technologies and systems.
- Equivalent combinations of education and experience may be considered.
Education
- Associate's degree or high school diploma with five years of health, workers' compensation claims, bill review, or finance experience, or an equivalent combination of education and experience.
Work Environment
- Remote position available only to candidates currently located in the United States and able to work without sponsorship.
- Requires a suitable private and quiet workspace.
- Work schedules are set to meet position and organizational needs and may be adjusted as necessary.
- Occasional travel to off-site locations for meetings may be required.
Compensation & Benefits
- Salary range: $45,000 - $67,000 annually.
- Comprehensive benefits package included.