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

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Demonstrates expertise in medical billing processes, including claims submission, follow-up, and resolution, while ensuring compliance with HIPAA regulations and maintaining confidentiality. Proficient in customer service and communication, with a strong understanding of revenue cycle operations and third-party reimbursement.

Highest-signal resume keywords

Medical Billing ExperienceClaims SubmissionRevenue Cycle OperationsCustomer Service SkillsHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationContractual Claims ProcessingCredit Balance ResolutionPayer RelationsStatistical ReportingBilling ReconciliationAccount Follow-UpClerical DutiesPayer Portal UsagePerformance Improvement Initiatives

Soft Skills

Excellent Communication SkillsTact and DiplomacyOrganizational SkillsProblem-Solving SkillsCustomer Service Etiquette

Tools & Technologies

Billing SoftwarePayer PortalsComputersFax MachinesTelephones

Industry Keywords

Third Party PayersPHIFederal Billing RegulationsState Billing RegulationsLocal Billing Regulations

About the role

Key responsibilities & impact

Submit accurate and timely claims to third party payers
Resolve claim edits and account errors prior to claim submission
Follow up with third party payers to ensure collections and exceed department goals
Gather statistics, complete reports, and perform clerical duties
Organize and execute daily tasks to maximize productivity, accountability, and efficiency
Comply with Notices of Privacy Practices and HIPAA regulations regarding 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
Attend educational programs, department meetings, teleconferences, and webcasts
Research and process mail returns and payer-rejected claims
Reconcile billing account transactions and process billing and follow-up transactions
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 the supervisor and manager to develop and exceed annual goals
Maintain confidentiality of demographic, clinical, and financial information
Communicate workflow problems to management in a timely manner

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 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 of time
Must have reading and comprehension ability
Visual acuity must be within normal range
Must be able to communicate effectively
Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment

Benefits

Comp & perks

40 scheduled weekly hours
Participation in educational programs for mandatory requirements, job growth, and personal growth