Claims Specialist - 257439

Posted 3 days ago

medixScottsdale (AZ)

Claims Adjusters, Examiners, and Investigators Claims Adjusting

SENIORITY

Senior

SALARY

$22–$24/Hour

Apply

About the role

Claims Specialist – Out-of-Network ClaimsRemote – Must Reside Arizona | $22–$24/Hour | Out-of-Network Experience REQUIREDMUST HAVE OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCERemote – Arizona Residents Only$22–$24/hour Equipment Provided Monday–Friday Monthly Bonus Potential

About the Role: We are seeking an experienced Claims Specialist with a strong background in OUT-OF-NETWORK BILLING AND CLAIMS to join a collaborative team specializing in air ambulance claims, member appeals, and insurance reimbursement. Out-of-network claims experience is a hard requirement for this position. Candidates must have hands-on experience working with out-of-network insurance claims and reimbursement. This is not a role where out-of-network billing can be learned from scratch. Air ambulance experience is a plus, but extensive training will be provided on the specific air ambulance processes. What we need you to already bring is a strong foundation in out-of-network claims, medical A/R, collections, and revenue cycle management. This is a detail-oriented role for someone who enjoys investigating complex claims, communicating with insurance companies and patients, and finding solutions rather than simply processing claims.

Key Responsibilities:

Manage approximately 25–30 insurance claims per day
Work extensively with OUT-OF-NETWORK CLAIMS and reimbursement
Research complex claim issues and determine appropriate resolution
Navigate commercial insurance requirements and out-of-network reimbursement processes
Perform eligibility and benefits verification
Apply air ambulance-specific eligibility and reimbursement criteria
Investigate and process member appeals
Gather and submit prior authorizations, medical records, and supporting documentation
Communicate with patients, families, employers, and insurance providers by phone, email, and online chat
Follow up with insurance companies regarding claim status, reimbursement, and outstanding issues
Maintain detailed and accurate claim documentation
Track productivity and quality metrics
Collaborate with the team and escalate complex issues appropriately
Proactively identify problems and ask questions when additional support is needed

Required Qualifications:

OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCE — REQUIRED2+ years of A/R and collections experience
Hands-on experience with OUT-OF-NETWORK medical billing/claims — REQUIREDExperience working with commercial insurance
Strong understanding of insurance claims and reimbursement processes
Strong critical-thinking and problem-solving abilities
Excellent verbal and written communication skills
Strong attention to detail
Ability to investigate complex claims rather than simply follow a repetitive workflow
Comfortable working across multiple systems and researching claim information
Adaptable, inquisitive, and willing to ask questions and escalate issues appropriately
Ability to work independently while contributing to a collaborative team
Preferred Experience
Air ambulance billing or claims
Hospital billing / RCMCritical care billing
Single-specialty healthcare billing
Medical collections
Member appeals
Prior authorization

Medical record requests?? Important Candidate RequirementOUT-OF-NETWORK CLAIMS EXPERIENCE IS A MUST-HAVE.We are specifically looking for candidates who have personally worked on out-of-network billing/claims and understand the challenges of obtaining reimbursement from commercial insurance plans. Candidates with only in-network billing experience will not be considered for this position. Air ambulance experience is preferred but not required — we will train the right candidate on the air ambulance-specific aspects of the role. Training & Schedule Initial Training: Approximately 90 days Monday–Friday, 6:00 AM–3:00 PM Arizona time8-hour shift with a 30-minute lunch Fully virtual training through Microsoft Teams Interactive training with screen sharing and ongoing support Post-Training: Monday–Friday Flexible start time between 6:00 AM–8:00 AM Arizona time Consistent start time once selected Remote WorkRemote – Arizona Must reside in Arizona Approximately 1 onsite day per month at the North Scottsdale office Equipment must be picked up in person on the first day Company provides: Laptop MonitorKeyboardMouseHeadsetMust have a reliable internet connection and HIPAA-compliant workspace

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.