Position Summary:
The Claims & Payment Specialist is responsible for reviewing claims, payment requests, receipts, supporting documentation, and reimbursement submissions to determine eligibility, compliance, and reimbursability based on established guidelines and requirements. This role requires strong analytical skills, attention to detail, sound judgment, and the ability to consistently apply policies while maintaining productivity expectations and documentation standards.
Essential Duties & Responsibilities:
- Review claims, reimbursement requests, payment submissions, receipts, invoices, and supporting documentation for completeness, accuracy, and compliance
- Evaluate expenses and payment requests against established policies, procedures, contracts, guidelines, and reimbursement requirements
- Determine claim eligibility and recommend approval, partial approval, denial, escalation, or additional review when appropriate
- Analyze submitted documentation to identify discrepancies, duplicate submissions, unsupported charges, missing documentation, or compliance concerns
- Review receipts, financial documentation, and supporting records to validate reimbursable expenses and payment eligibility
- Process, document, and maintain accurate records related to approvals, denials, payment recommendations, and claim outcomes
- Maintain detailed documentation, audit trails, tracking logs, and supporting records for compliance and operational purposes
- Communicate professionally with staff, clients, vendors, and stakeholders regarding deficiencies, documentation requirements, payment questions, or claim status
- Perform scanning, electronic filing, document retention, record maintenance, and data entry activities
- Generate reports, monitor productivity metrics, and support operational and compliance reporting requirements
- Support additional administrative, financial, operational, and compliance-related duties as assigned
Required Qualifications:
- High school diploma or equivalent required
- Associate degree in accounting, finance, business administration, healthcare administration, or related field preferred
- Minimum two years of experience in claims processing, reimbursement review, accounting, finance, compliance, insurance, auditing, expense review, payment processing, or related fields preferred
- Strong analytical and decision-making skills with the ability to apply policies consistently
- Excellent attention to detail and organizational skills
- Strong written and verbal communication skills
- Proficiency with spreadsheets, databases, document management systems, and Microsoft Office applications
- Ability to manage multiple priorities and maintain productivity standards in a deadline-driven environment
Preferred Qualifications:
- Experience reviewing claims, reimbursement requests, expense reports, invoices, receipts, or financial documentation
- Experience working with compliance requirements, approval workflows, audit processes, or quality control procedures
- Experience working within claims management systems, ERP systems, accounting software, or workflow management tools preferred
Physical Requirements:
- Ability to occasionally lift and carry up to 30 pounds
- Ability to sit and work at a computer for extended periods
Schedule:
Employment Type: Full-Time
Schedule: Standard business hours with additional hours as operationally required