experience in customer service and processing medical claims; r espond promptly and courteously to incoming phone calls from medical providers, billing agents, and recipients regarding correct Medicaid claim submission, claim status, and reimbursement through billing guidelines, policies, and procedures; r eview claim records, system information, policy manuals, and fee schedules to identify submission errors, missing data, or processing discrepancies; process medical claims that stop for manual review between incoming calls; p rovide clear and courteous guidance over the phone, helping callers resolve issues related to denials, adjustments, coordination of benefits, and prior authorizations; c ollaborate with other internal departments to address complex claims or policy questions that require further investigation or higher-level approval; m onitor and track claim statuses, follow up on unresolved cases, and ensure that documentation is updated accurately and completely; e ducate providers on self-service tools such as electronic eligibility verification systems, diagnosis/procedure code lookup tools, claims submission portals, and online manuals/fee schedules; m aintain confidentiality and security of sensitive health and financial data in compliance with HIPAA and state regulations on confidentiality and security of health and finance data; stay updated on changes to Medicaid policies, billing codes, and claim system processes. The South Dakota Department of Social Services (DSS) is seeking a detail-oriented and service-driven Claims Advice and Processing Specialist to support the operations of South Dakota Medicaid.