Insurance Claims Specialist (US Medical Billing)

Roles & Responsibilities:-

Insurance Calling & Claim Follow-Up

• Call US insurance companies to verify claim status, eligibility, and gather detailed information on pending or denied claims.
• Accurately document all interactions in the billing or practice management system.
• Identify reasons for delays, rejections, or denials and take necessary action.
• Perform timely follow-up to ensure claims move toward payment.

Denial Management

• Review denial codes and analyze payer responses to determine the cause.
• Coordinate with billing teams, hospitals, and doctors to correct and reprocess claims.
• Assist in preparing appeals and tracking corrected claims until closure.

Payment Posting

• Post insurance payments (ERA/EOB) accurately into US hospital or practice management software.
• Reconcile daily deposit batches and highlight underpayments or discrepancies.
• Maintain consistent accuracy with adjustments and financial records.

Documentation & Compliance

• Maintain updated notes, logs, and claim follow-up records.
• Follow HIPAA and US healthcare compliance guidelines.
• Achieve daily productivity and quality benchmarks.

Communication & Coordination

• Communicate effectively with internal teams, US clients, doctors, and patients when required.
• Highlight recurring denial trends and payer issues.
• Participate in training and process improvement initiatives.