Insurance Claims Specialist

WVU Medicine

. Submit accurate and timely claims to third-party payers .

Posted 11/6/2026full-timeRemote • United 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 claims submission, denial resolution, and compliance with HIPAA regulations. Proficient in utilizing payer portals and maintaining productivity while providing excellent customer service.

Highest-signal resume keywords

Medical Billing ExperienceICD-10 Coding KnowledgeCPT Coding KnowledgeRevenue Cycle OperationsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims SubmissionClaims AdjudicationContractual Claims ProcessingCredit Balance ResolutionBusiness MathMedical TerminologyPayer RelationsAccount ReconciliationStatistical ReportingFollow-Up Procedures

Soft Skills

Customer ServiceTelephone EtiquetteOrganizational SkillsProblem-SolvingAccountability

Tools & Technologies

Payer PortalsBilling SoftwareFax MachinesComputersTelephones

Industry Keywords

HIPAA ComplianceThird-Party PayersClaims ProcessingRevenue Cycle ManagementHealthcare Billing Regulations

About the role

Key responsibilities & impact

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, complete reports, and perform scheduled or requested duties
Organize and prioritize daily tasks for productivity, accountability, and efficiency
Comply with Notices of Privacy Practices and HIPAA regulations for PHI and claim submission/follow-up
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
Participate in educational programs, department meetings, teleconferences, and webcasts
Research and process returned mail and payer-rejected claims
Reconcile billing account transactions and process billing and follow-up transactions accurately and timely
Maintain knowledge of federal, state, and local professional 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
Work with supervisors and managers to develop and exceed annual goals
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
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
Ability to sit for extended periods
Reading and comprehension ability
Visual acuity within normal range
Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment
Must be able to communicate effectively

Benefits

Comp & perks

Full-time schedule of 40 hours per week
Participation in educational programs for mandatory requirements and job/personal growth
Performance improvement initiatives
Reasonable accommodations for individuals with disabilities