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1 result for Billinginvoice Specialist in Albuquerque, NM
- Albuquerque, NM
- remote
- Temporary / Contract
- 15 - 16 USD / Hourly
- <p>We are looking for a detail-oriented Medical Insurance Claims Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of claims processing within the healthcare industry. Working remotely but closely with the team based in San Diego, California, you will help support better financial and member outcomes while contributing to a collaborative and fast-paced environment. NOTE: (Only for New Mexico Residents) </p><p><br></p><p>Responsibilities:</p><p>• Conduct audits of pre-lag reports to verify accuracy, completeness, and compliance with established turnaround times.</p><p>• Investigate and resolve member out-of-pocket concerns to ensure proper claims adjustments.</p><p>• Monitor daily pre-lag reports for assigned regions and escalate compliance issues as needed.</p><p>• Analyze daily, weekly, and check-run reports for assigned IPAs to identify potential errors or inconsistencies.</p><p>• Notify management promptly about compliance concerns related to claims payment timelines.</p><p>• Perform quality reviews of claims processes to ensure adherence to organizational standards.</p><p>• Collaborate with team members to identify trends and root causes of recurring issues.</p><p>• Assist with benefit interpretation and claims adjustments using EZCap or similar platforms.</p><p>• Maintain documentation and provide detailed audit reports to support continuous improvement initiatives.</p><p>• Support the implementation of quality measures and compliance protocols within claims operations.</p>
- 2026-04-14T00:00:00Z