Claims Specialist

🕒 June 26

🇺🇸 United States – Remote

💵 $34 - $37 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 19%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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GeneDx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🧬 Biotechnology

🏥 Healthcare

🤖 Artificial Intelligence

Biotechnology • Healthcare • Artificial Intelligence

GeneDx is a biotechnology company dedicated to providing personalized and targeted medical care through genetic diagnosis. Leveraging one of the largest datasets for rare diseases, GeneDx offers advanced testing such as whole genome and exome sequencing. Their diagnostic solutions translate complex genomic information into actionable insights, facilitating personalized health plans, enhancing drug discovery, and improving the efficiency of healthcare systems.

📋 Description

• Manage the end-to-end claims process for diagnostic laboratory services • Prepare, review, and submit claims to commercial and government payers in compliance with payer guidelines and laboratory policies • Analyze denied claims, identify root causes, and initiate corrective actions, including appeals and resubmissions • Follow up on outstanding claims, monitor aging reports, communicate with payers, and expedite payment • Maintain accurate records of claim status, correspondence, and payer responses in the billing system • Collaborate with prior authorization, billing, and reimbursement teams on complex claims and cross-functional RCM initiatives • Stay current with payer requirements, CPT and ICD-10 coding updates, and regulatory changes • Generate and analyze claims performance reports to identify trends and process improvement opportunities and support management decisions • Perform other related duties as assigned by the supervisor

🎯 Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred) • 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting • Strong knowledge of insurance billing, payer requirements, and denial management • Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice • Proficiency with billing software and Microsoft Office Suite • Excellent attention to detail, organizational, and communication skills • Ability to work independently and collaboratively in a fast-paced environment • Reliable high-speed internet access • Standard office equipment including computer, phone, and video conferencing tools • Ability to sit for extended periods, up to 8 hours per day • Repetitive use of hands and fingers for typing and mouse operation • Visual acuity for reading computer screens and documents • Ability to communicate effectively via phone and video calls • Occasional lifting of up to 10 pounds

🏖️ Benefits

• Competitive compensation and benefits reflecting local market practices and legal requirements in each country where GeneDx operates • Reasonable accommodations for individuals with disabilities