CLAIMS REVIEW SPECIALIST

Date: Mar 16, 2026

Req ID: 55090

Location:

Little Rock, AR, US, 72201

Category: AR DEPT OF HUMAN SERVICES

Anticipated Starting Salary: $39,170.98

Position Number: 22099403
County: Pulaski
Posting End Date: March 31, 2026

Job Duties:

The function of this position requires flexibility with ever-changing priorities and administrative directives. The Claims Review Specialist works under general supervision and is responsible for providing clerical and technical support to supervisory, medical, and other professional Utilization Review staff. Significant functions of this position include assisting with Medicaid Provider & Beneficiary Appeal Requests and administrative duties related to UR audits. Position utilizes specialized programs including, but not limited to, MMIS Interchange, SharePoint, Adobe, Word, Docushare, and Excel. This position is governed by state and federal laws and agency policy.

Preferred Qualifications:

1. Communication skills-as this is a help desk and call center for members and providers.

2. Preferable pharmacy technician experience including knowledge of Medicaid.

3. If no pharmacy technician experience, preferable to have knowledge of DHS/DMS programs to assist with pharmacy help center calls.

4. Experience/proficiency with Excel

5. History of auditing or oversight on projects

The Department of Human Services is a place for people passionate about serving others and changing lives for the better. We care for Arkansans of all ages and ensure places like child care centers and nursing homes are safe. We are the safety net for the most vulnerable Arkansans. Whether you answer the phones, take applications, protect children, or help care for residents or patients at one of our facilities, you make a difference by working at DHS. Plus, working for the State has great perks, including a pension, maternity leave, paid state holidays, and much more. At DHS, we take care of our employees so you can help care for others.

Position Information

Job Series: Program Operations – Claims Review

Classification: Claims Review Specialist

Class Code: PCR02P

Pay Grade: SGS03

Salary Range: $39,171 – $57,973

Job Summary

The Claims Review Specialist plays a critical role in supporting the insurance claims process by reviewing and evaluating claims for accuracy, completeness, and compliance with pre-determined agency policies and regulatory standards. This classification involves verifying claim documentation, investigating discrepancies, and ensuring the timely and efficient resolution of claims.

Primary Responsibilities

Assess insurance claims to ensure all required information is accurate and complete. Verify claim documentation against policy terms and conditions. Identify missing or inconsistent information and coordinate with the appropriate personnel to resolve issues. Document findings and actions taken for each claim in an organized manner. Communicate claim outcomes and provide necessary explanations to policyholders or internal personnel. Support fraud detection and prevention efforts by reporting unusual patterns or inconsistencies. Stay informed on agency policies, industry practices, and relevant regulations. Collaborate with senior team members and managers to improve claims processing workflows.

Knowledge and Skills

Strong analytical and problem-solving skills, attention to detail, good written and verbal communication. Willingness to learn and adapt to new tools, technologies, and processes. Experience with using standard office software (e.g., Microsoft Excel, Word). A proactive and team-oriented approach to work. Familiarity with department related programs.

Minimum Qualifications

High school diploma or GED.

Two years of experience in clerical or administrative functions.

Satisfaction of the minimum qualifications, including years of experience and service, does not entitle employees to automatic progression within the job series. Promotion to the next classification level is at the discretion of the department and the Office of Personnel Management, taking into consideration the employee’s demonstrated skills, competencies, performance, workload responsibilities, and organizational needs.

Licensure/Certifications

N/A OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

The State of Arkansas is committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, pregnancy, age, disability, citizenship, national origin, genetic information, military or veteran status, or any other status or characteristic protected by law.