Claim specialist

We are seeking a highly motivated and productivity-driven Claims Follow-Up Representative to join our team. This role focuses exclusively on managing and resolving out-of-network (OON) commercial insurance claims. You will be responsible for directly contacting insurance payers to investigate claim statuses, appeal denials, and optimize overall workflow efficiency. This position requires high-volume phone outreach and meticulous electronic documentation. Key Responsibilities High-Volume Claim Management: Manage, review, and work a strict minimum of 75 commercial insurance claims per day. Direct Payer Contact: Conduct phone calls for every single claim to resolve issues directly with insurance payers; portal-only research is insufficient. Denial Tracking & Escalations: Identify high-dollar claims for prioritization and follow standard protocols for denial follow-ups and payer escalations. Data Documentation: Maintain flawless, real-time documentation of claim actions within our EMR syst...