Sr Claims Specialist

Salary Range: $63,080.00/yr - $82,792.50/yr

This is an exempt position. Pay rates are based on education, skill, experience level and internal equity.

Follow Your Calling, Find Your Career
The Finance Department is a team of professionals that are tasked with functions including capital and debt planning, investments, accounting, payroll, procurement, grant management and payables along with providing additional fiscal support to departments across the County.  The Ideal candidate will perform professional and complex accounting work involving the preparation and/or maintenance of financial or related records. This position, under minimal supervision, is responsible for establishing and maintaining financial records which may include budgets, expenditures, and revenues. Prepare, review, analyze, and submit a variety of complex and/or special reports, reconciliations, work papers, communications, schedules, tables, and/or statements to and from internal departments, financial institutions, and external agencies.

POSITION SUMMARY
Mecklenburg County is excited to welcome a Senior Claims Specialist to our Finance Department. This role serves as the Claims Specialist Lead within the revenue cycle function, serving as the subject matter resource of complex claims and collection activities while sharing improvement measures required for accurate charge capture. In addition to handling high level insurance appeals (Levels 2–5), this role will drive process optimization, evaluate denial trends, and conduct A/R analyses that inform budget planning and fiscal year projections. The selected candidate will be accountable for ensuring quality, compliance, training, and continuous improvement across all claims workflows and for translating operational insights into strategic recommendations for leadership.

ESSENTIAL FUNCTIONS
•Claims Coordination & Quality Assurance
o Provide coordination of claim submission quality and accuracy across all programs and payer types
o Monitor coding compliance and provide ongoing staff education to maintain adherence to standards
o Point of contact into any payment posting and reconciliation to ensure accuracy of financial records
o Maintain and update standard operating procedures (SOPs) and workflow documentation
o Serve as liaison with clinical departments to drive documentation improvement that supports clean claims

•Appeals, Denials & Collections
o Personally manage and resolve complex, escalated appeals (Level 2–5) for private health care and government payer denials
o Analyze denial patterns to identify root causes and implement corrective process improvements
o Develop, implement, and continuously refine collection protocols and escalation best practices
o Coordinate insurance follow-up activity and manage escalation pathways for aged or high-risk accounts
o Oversee monitoring of past-due accounts and ensure appropriate handling per uncollectible account policy

•Team Training
o Take the lead on technical claims processes, tools, and best practices
o Coordination of training materials and act as a subject-matter resource for internal departments, financial institutions, and external agencies
o Coach team members on quality standards

•Analytics & Financial Reporting
o Produce A/R analytics and denial-pattern analysis to support budget and fiscal-year forecasting
o Gather and analyze financial trends to identify gaps and inform budget and fiscal-year projections
o Participate in special projects related to revenue cycle and financial performance initiatives

MINIMUM QUALIFICATIONS
Experience: 5+ years of progressive experience in medical claims, billing, or revenue cycle operations, including experience with complex/multi-level appeals

Education: Associate's or Bachelor's degree in Healthcare Administration, Business, Finance, or a related field (or equivalent experience)

Combination of relevant education and relevant experience accepted?: Yes

PREFERRED QUALIFICATIONS
•Extensive experience mentoring, training, or informally leading a team highly preferred

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge:
•Strong working knowledge of payer requirements, coding compliance, and appeal processes (Level 2–5) for private and government payers

Skills:
•Advanced analytical skills, including denial trend analysis and A/R/KPI reporting
•Demonstrated ability to develop and improve operational processes and SOPs
•Strong leadership, coaching, and training capabilities
•Excellent judgment and decision-making for day-to-day operational issues
•Proficiency with claims/financial management systems and reporting tools

Abilities:
•Ability to work collegially across departments and respond efficiently under pressure

WORK ENVIRONMENT
Works in an office setting with moderate noise

REASONABLE ACCOMMODATIONS STATEMENT
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

DISCLAIMER STATEMENT
This is not intended to be an all-inclusive list of job-related responsibilities, duties, skills, requirements or working conditions. Other duties may be assigned based on business need and the supervisor’s request. Mecklenburg County reserves the right to revise the job description at any time. Designated positions may be required to assist in emergency and/or disaster situations.