You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Medical Claims Specialist to join their team. This role primarily focuses on high-volume outbound calls to workers' compensation insurance carriers, proactively checking claim statuses, following up on aged and current inventory, and meticulously obtaining necessary documentation such as EOBs/EORs, implant invoices, and operative reports. The Medical Claims Specialist will be instrumental in investigating unpaid bills, initiating recovery steps, and managing persistent queue follow-ups. There is a clear path for growth into more complex areas like appeals, fee schedule calculations, and settlement negotiations.

Key Responsibilities

• Perform high-volume outbound calls to workers' compensation insurance carriers to check claim status, follow up on aged and current inventory, and obtain necessary documentation (e.g., EOBs/EORs, implant invoices, operative reports).
• Act as a "sleuth" to figure out why bills haven't paid and initiate next steps to drive recovery (sending form letters via collection software, faxing reconsiderations for missing medical records, and sending detailed spreadsheets to healthcare provider clients showing what is needed from them).
• Navigate carrier call limits (time/account caps per call) by cycling back into queues and making 3–4+ follow-up calls when documentation isn't received.
• Growth / Advanced Duties (once ramped up): Prepare and submit appeals, perform fee schedule calculations, apply PPO contracts, and eventually negotiate settlements with carriers/attorneys.

Qualifications

• 2+ years of experience in a medical office/setting.
• Proven experience making outbound calls to insurance carriers for claim status and obtaining documentation.
• Strong keyboarding/typing skills and attention to detail/accuracy.
• High level of professionalism (must comport themselves appropriately in written and verbal communications).
• Comfort and resilience with repetitive, task-oriented phone work.

Experience

• Minimum 2+ years of experience in a medical office or setting.
• Prior Workers' Compensation experience (auto/MVA or third-party liability claims experience is also transferable) is preferred.
• Experience submitting reconsiderations (especially medical record reconsiderations via fax) is preferred.
• Background in healthcare coding, fee schedules, or commercial health billing is preferred.

Skills

• Strong keyboarding/typing skills.
• Exceptional attention to detail and accuracy.
• High level of professionalism in all written and verbal communications.
• Resilience and comfort with repetitive, task-oriented phone work.

Education

• High school diploma or equivalent.
• Associate/Bachelor’s degree or ABA paralegal certification is preferred.

Additional Requirements

• Standard business hours: Monday – Friday, 8:30 AM – 5:00 PM (40 hours/week); consistent schedule required.
• Flexibility available to align with carrier call center hours across time zones (e.g., matching an early shift of ~7:00/7:30 AM – 3:30/4:00 PM, or front-loading hours earlier in the week to leave early on Friday).

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.