Claims Specialist (Dispute Resolution)

• Please Note: Associates/Bachelor's Degree Required*

Pay Rate: $20.00 – $25.00/hour Location: Remote (U.S. Based) Contract: 6–12 months + (I.e. Indefinite Contract) Schedule: Monday–Friday, 8:00 AM – 5:30 PM Equipment: Provided! About the Opportunity Medix is partnering with a nationally recognized healthcare quality and review organization to hire Claims Specialists supporting medical claims appeal and dispute resolution programs. As part of a growing initiative, this team plays a critical role in ensuring medical claims are reviewed efficiently, documentation is processed accurately, and cases move through the review process in accordance with established quality and compliance standards. This is an excellent opportunity for professionals with healthcare administration or medical claims experience who enjoy investigative work, cross-functional collaboration, and managing complex case workflows in a remote environment. Position Overview The Claims Specialist supports the resolution of medical claims disputes and appeals through end-to-end case coordination, documentation management, and communication with internal and external stakeholders. This role serves as a liaison between healthcare plans, providers, patients, and clinical review teams to ensure cases are processed accurately and within established deadlines. Success in this role requires strong organizational skills, attention to detail, effective communication, and the ability to manage multiple priorities in a fast-paced, deadline-driven environment.

Key Responsibilities

• Serve as the primary point of contact for medical claims appeal and dispute resolution programs
• Coordinate communication between healthcare plans, providers, patients, clients, and internal teams
• Monitor appeal/dispute status through client portals and internal tracking systems
• Conduct initial eligibility and case reviews, escalating recommendations to internal leadership as needed
• Track, assign, and manage cases using internal workflow systems
• Compile and distribute case documentation to clinical reviewers, including coders, nurses, physicians, and other stakeholders
• Ensure timely completion of deliverables while maintaining quality and compliance standards
• Monitor key performance indicators (KPIs), including turnaround time, accuracy, and contract requirements
• Identify workflow barriers and recommend process improvements
• Participate in daily/regular team huddles and provide case status updates in an agile workflow environment
• Schedule meetings, document decisions, and track next steps/action items
• Prepare and submit billing invoices upon case completion and coordinate with finance/accounting teams
• Train and mentor new team members on processes and case progression
• Other duties as assigned

Required Qualifications

• Associate’s or Bachelor’s degree in Healthcare, Business, Management, Digital Studies, or related field
• Minimum 2 years of experience in healthcare administration, medical claims, appeals, case management, or related field
• Strong written and verbal communication skills, including professional phone etiquette
• Ability to work independently with minimal supervision
• Strong problem-solving skills and ability to collaborate across clinical and administrative teams
• Ability to manage multiple priorities in a deadline-driven environment
• Flexible, adaptable, and comfortable working in a fast-paced workflow environment

Technical Skills

• Experience with internal case management or workflow systems (training provided)
• Proficiency with Microsoft Office Suite (Excel, Outlook, Word)
• Comfortable working with electronic documentation and tracking tools

Training & Onboarding

• 2–4 week structured training program provided
• Training includes systems navigation, workflow processes, and case handling procedures
• Ongoing support provided during ramp-up period

Preferred Qualifications

• Prior experience with medical claims, appeals, utilization review, or revenue cycle operations
• Exposure to payer/provider communication workflows
• Experience working in high-volume case processing environments

Additional Information

• Equipment provided for remote work
• Temporary equipment deposit policy applies: $50/week deducted for 10 weeks ($500 total), fully refunded after 10 weeks upon compliance with policy
• Onboarding includes background check, drug screening, and health screening
• Business casual dress code (professional virtual environment expected)
• Employment is through Medix for the duration of the assignment