Senior Medical Claims Specialist

At the Vitrolife Group, we work every day to unlock the full potential of science and technology to reduce the barriers towards building a family. Together we help our customers and their patients to fulfill the dream of having a baby.

We are seeking a detail-oriented and experienced Senior Medical Claims Specialist who has a history of streamlining processes, while completing daily activities efficiently and accurately. In this role, you will be responsible for managing complex medical claims, ensuring accurate processing, compliance with regulations, and delivering exceptional service to clients and providers.

Key Responsibilities: 

• Review, analyze, and process complex medical claims efficiently and accurately.
• Validate claim information and ensure adherence to policy guidelines and regulatory requirements.
• Investigate and resolve claim discrepancies, denials, and appeals.
• Collaborate with healthcare providers, patients, and internal teams to address claim issues.
• Maintain thorough documentation of claim activities and maintain accurate records.
• Ensure timely payment posting for all insurance payers.
• Monitor insurance payer receivables to ensure past due claims are being resolved.
• Identify opportunities to enhance efficiency with claims processing and payment workflows.
• Support insurance payer contracting and compliance, as needed
• Stay informed about evolving industry regulations, policies, and best practices.
• Mentor and support junior team members, providing guidance and training.

Education & Qualifications: 

• Associate’s degree in healthcare administration or related field preferred.
• Minimum of 5+ years' experience in medical claims processing or related field

Knowledge, Skills and Abilities:

• Strong knowledge of ICD-10, CPT coding requirements.
• Excellent analytical, problem-solving, and organizational skills.
• Proficient in claims processing software and Microsoft Office Suite.
• Strong communication and interpersonal skills.
• Ability to work independently and handle multiple priorities effectively

Benefits:

• 401(k) with Employer Match
• Medical/Dental/Vision/ GAP insurance
• Basic Life and AD&D
• Short / Long Term Disability
• Critical Illness and Accident Insurance
• Employee Assistance Program
• Flexible Spending & Health Savings Account
• Paid Time Off
• 10 Paid Holidays

An offer of employment is contingent on the successful passing of a background check. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.

Vitrolife Group is a global provider of medical devices and genetic services. Based on science and advanced research capabilities, we develop services and products for personalized genetic information and medical device products. We support our customers by improving their clinical practice for the patient's outcome of fertility treatment.

We are currently approximately 1 100 colleagues worldwide, with headquarters in Gothenburg, Sweden. Vitrolife Group's products and services are available in more than 110 countries through our own presence in 30 countries and a network of distributors. Vitrolife Group is a sustainable market leader and aims to be the preferred partner for IVF-clinics by providing superior products and services with the vision of fulfilling the dream of having a baby. The Vitrolife share is listed on Nasdaq Stockholm.