Insurance Claims Specialist

WVU Medicine

. Manage patient account balances through accurate claim submission, regulatory compliance, timely follow-up, and denial management .

Posted 9/22/2026full-timeUnited StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical billing processes, including claim submission, denial management, and compliance with HIPAA regulations. Proficient in customer service, communication, and maintaining productivity in a fast-paced environment.

Highest-signal resume keywords

Medical Billing ExperienceICD-10 Coding KnowledgeCPT Coding KnowledgeRevenue Cycle OperationsCustomer Service Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claim SubmissionDenial ManagementBilling ReconciliationBusiness MathMedical TerminologyPayer RelationsClaims AdjudicationContractual Claims ProcessingCredit Balance ResolutionRegulatory Compliance

Soft Skills

Excellent Communication SkillsTact and DiplomacyCustomer Service EtiquetteOrganizational SkillsProblem-Solving Skills

Tools & Technologies

Payer PortalsBilling SoftwareOffice Equipment

Industry Keywords

HIPAA ComplianceThird Party ReimbursementHealthcare Billing RegulationsPatient Account Management

About the role

Key responsibilities & impact

Manage patient account balances through accurate claim submission, regulatory compliance, timely follow-up, and denial management
Provide customer support and resolve issues from customer inquiries
Complete reports and clerical duties as needed
Submit accurate and timely claims to third-party payers
Resolve claim edits and account errors before claim submission
Follow up with third-party payers to support collections and department goals
Gather statistics and complete reports
Organize and prioritize daily tasks for productivity, accountability, and efficiency
Comply with HIPAA regulations and Notices of Privacy Practices
Contact third-party payers to resolve unpaid claims
Use payer portals and websites to verify claim status and conduct account follow-up
Assist Patient Access and Care Management with denial investigation and resolution
Attend department meetings, teleconferences, and webcasts as needed
Research and process returned mail and payer-rejected claims
Reconcile billing account transactions and process billing and follow-up transactions
Maintain knowledge of federal, state, and local hospital-billing regulations
Monitor accounts to facilitate timely follow-up and maximize cash receipts
Maintain work queue volumes and productivity within established guidelines
Provide customer service to patients, visitors, and employees
Participate in performance improvement initiatives
Develop and exceed annual goals with supervisor and manager
Maintain confidentiality of demographic, clinical, and financial information
Communicate workflow problems to management promptly

Requirements

What you’ll need

High School diploma or equivalent
One (1) year medical billing/medical office experience preferred
Excellent oral and written communication skills
Working knowledge of computers
Excellent customer service and telephone etiquette
Ability to use tact and diplomacy in dealing with others
Knowledge of medical terminology preferred
Knowledge of business math preferred
Knowledge of ICD-10 and CPT coding processes preferred
Knowledge of revenue cycle operations, third party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures
Ability to understand written and oral communication
Must be able to sit for extended periods
Must have reading and comprehension ability
Visual acuity within normal range
Must be able to communicate effectively
Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment
Ability to work in the United States of America

Benefits

Comp & perks

40 scheduled hours per week
Participation in educational programs for mandatory requirements, job growth, and personal growth
Remote location designation