Insurance Claims Support Specialist | Patient Financial Services

Insurance Claims Support Specialist 💻 Work Style: Onsite📍 Location Requirement: Gainesville, FL🕒 FTE: Full-Time (1.0 FTE) Manages and evaluates insurance claims to ensure accurate coverage and timely processing. Investigates claims, negotiates settlements, and responds to inquiries from claimants and related parties. Assists clients in submitting claims correctly and coordinates with internal teams to facilitate efficient claim resolution.

Maintains detailed records and verifies claim compliance are key to supporting audit and regulatory requirements. ResponsibilitiesThe Insurance Claims Support Specialist is responsible for a wide range of administrative and operational tasks, including but not limited to:Review medical record request via Availity and route to UF ROI department. Medical record follow - up with payer to ensure records are received and in processPayer Correspondence follow upDocument accounts in the Epic system for correspondence, follow up and outgoing mail.

Managing the intake and separation of incoming mailed correspondence from insurance payers, ensuring documentation is properly reviewed and accurately batched for scanning. Serving as a liaison for Insurance Claim Specialists by coordinating outgoing mail and faxes to patients and insurance payers. Reviewing and evaluating paper claims, analyzing claim information for appropriate mailing.

Demonstrating a thorough understanding of insurance processes and requirements. Possessing strong analytical skills to evaluate large volumes of data and identify patterns or trends related to insurance payer demographic updates. Any other duties outlined by the department QualificationsEducationHigh School Diploma/EquivalentJob

2+ year's experience in insurance claims processing and supportKnowledge of insurance policies and claim adjudicationExperience investigating and resolving claim issuesStrong communication and customer service skillsAbility to maintain detailed records and ensure compliance

Experience working with Availity insurance systemRequires a minimum of six months of billing experience in a hospital and/or physician’s office, OR at least one year of experience in a business setting involving finance, accounting, or insurance portal systems. Ability to accurately verify patient insurance eligibilityPrefer experience working with commercial and government payers, including BCBS, Medicare, Medicaid, and other third-party insurance carriers.

Must have above-average math skills and be proficient with a calculator. Demonstrated ability to communicate effectively with others and to work independently under pressure while consistently achieving desired results. Must be able to interact effectively with the public and exercise good judgment in resolving accounts.

Knowledge of medical terminology is preferred. Experience with computerized insurance billing systems and Microsoft programs is preferred. Epic experience is required.

Working effectively under pressure while maintaining accuracy and attention to detail.