Healthcare Claims Review Specialist

Job Description

Location: Dallas, TX

This is a full-time work-from-home position. Employees must be located in or within a commutable distance to the Dallas–Fort Worth area to attend required onsite training.

We are seeking a Healthcare Claims Review Specialist to support clinical and financial oversight activities related to healthcare reimbursement. This role focuses on reviewing medical claims and supporting documentation to identify billing accuracy issues, reimbursement variances, and compliance considerations.

The ideal candidate has a clinical background, strong analytical skills, and experience working with healthcare documentation or claims in a non-bedside environment.

Key Responsibilities:

• Review healthcare claims and related documentation to evaluate billing accuracy and reimbursement alignment.
• Analyze medical records and supporting documentation to identify potential discrepancies or variances.
• Apply clinical knowledge when assessing services, procedures, and documentation.
• Prepare clear written summaries outlining findings and recommendations.
• Follow established review guidelines, quality benchmarks, and compliance standards.
• Participate in training sessions, team meetings, and ongoing education activities.
• Collaborate with internal clinical and operational partners as needed.
• Support additional review or analysis projects as assigned.

Qualifications:

• Active, unrestricted clinical license (RN, LPN, or LVN) in the state of employment.
• Minimum of two years of experience in a healthcare setting involving documentation review, claims support, utilization review, or revenue-related functions.
• Prior acute care clinical experience preferred but not required.
• Familiarity with healthcare billing, reimbursement concepts, or claims workflows.
• Strong analytical skills with high attention to detail.
• Ability to interpret medical documentation and apply sound clinical judgment.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office tools, including Excel and Outlook.
• Ability to manage multiple priorities in a structured, remote work environment.

Schedule & Work Environment:

• Full-time, work-from-home position.
• Standard weekday schedule.
• Required onsite training in the Dallas–Fort Worth area.

Salary Range:

The salary range for this position is $65,000 – $95,000 annually (approximately $31.25 – $45.67 per hour), based on experience.

Interview Process:

Selected candidates will participate in a multi-step interview process, which will include a screening call with TalentLNX, followed by virtual interviews with clinical and operational stakeholders.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.