Claims Specialist - 257439

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 time 8-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 Work Remote – 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 Monitor Keyboard Mouse Headset Must have a reliable internet connection and HIPAA-compliant workspace