[Hiring] Claims Specialist REMOTE USA
Position: Claims Specialist
Date Posted: November 27, 2025
Industry: Healthcare / Diagnostic Laboratory Services
Employment Type: Full Time
Experience: 2+ years in medical claims processing
Qualification: Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field (preferred)
Salary: $34—$37 USD
Location: United States REMOTE
Company: GeneDx
Description:
GeneDx is seeking a Claims Specialist to manage the end-to-end claims process for diagnostic laboratory services, ensuring accurate submission, follow-up, and resolution of insurance claims. This role is vital in maximizing reimbursements, reducing denials, and supporting the laboratory’s financial health.
Key Responsibilities:
• Claims Submission: Prepare, review, and submit claims to commercial and government payers, ensuring compliance with guidelines and laboratory policies.
• Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions, including appeals and resubmissions.
• Follow-Up: Monitor outstanding claims, track aging reports, and communicate with payers to resolve issues efficiently.
• Documentation: Maintain precise records of claim status, correspondence, and payer responses in the billing system.
• Collaboration: Work closely with prior authorization, billing, and reimbursement teams to handle complex claims and support RCM initiatives.
• Compliance: Stay updated on payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting lab claims.
• Reporting: Generate and analyze claims performance reports to identify trends and opportunities for process improvement.
Qualifications & Skills:
• 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.
• Strong knowledge of insurance billing, payer requirements, and denial management.
• Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice.
• Proficiency with billing software and Microsoft Office Suite.
• Excellent attention to detail, organizational, and communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.
Physical Demands:
• Sedentary role with prolonged periods of sitting (up to 8 hours per day)
• Repetitive use of hands and fingers for typing and mouse operation
• Visual acuity for reading computer screens and documents
• Ability to communicate effectively via phone and video calls
• Occasional lifting up to 10 pounds
Work Environment:
• Fully remote position; work from home or suitable remote location with reliable high-speed internet
• Climate-controlled environment using standard office equipment (computer, phone, video tools)
• Work schedule coordinated with leadership and may adjust with business needs
Culture & Benefits:
• GeneDx fosters a collaborative, innovative, and patient-focused environment
• Paid Time Off (PTO), Health, Dental, Vision, Life Insurance
• 401(k) Retirement Savings Plan, Employee Discounts, Voluntary Benefits
• Equal Opportunity Employer committed to growth, collaboration, and impactful work in genomic science
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