Account Resolution Specialist – Insurance HMOs

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct research and resolve pending insurance claims, including those that are unreleasable, denied, or inaccurately paid.

• Examine claims that are on hold, identify the underlying causes, rectify errors, and follow up to facilitate claim releases.

• Analyze insurance denials and manage appeals, corrections, or resubmissions as necessary.

• Reach out to insurance carriers via phone to ascertain claim status and clarify any discrepancies.

• Prepare and submit the documentation requested by insurance providers.

• Create and submit appeals that are backed by appropriate documentation, regulatory guidelines, and payer specifications.

• Handle incoming correspondence, which includes mail, emails, EOBs, information requests, and refunds.

• Keep detailed records in billing systems regarding follow-up activities, findings, and next steps.

• Identify recurring issues and escalate concerns to supervisors or relevant internal teams.

• Achieve daily productivity and accuracy goals.

⛳️ Requirements

• High School Diploma or an equivalent qualification is required.

• Proficient computer skills, including a working knowledge of MS Outlook, Word, and Excel.

• Ability to type 40 WPM with a focus on accuracy.

• Capacity to manage high-volume workloads, prioritize tasks effectively, and meet strict deadlines.

• Experience in a structured environment utilizing call monitoring, performance metrics, or productivity scoring is advantageous.

• Strong verbal communication skills for professional interactions with insurance carriers over the phone.

• Excellent written communication abilities for documentation and correspondence purposes.

• Outstanding attention to detail and accuracy in reviewing claims and spotting discrepancies.

• Highly organized, self-motivated, and capable of independently managing work in a remote setting.

• Reliable, punctual, and accountable in all responsibilities.

• Ability to independently oversee all job duties, objectives, and business practices in a remote environment.

🏝️ Benefits

• Competitive salary, aligned with experience.

• Comprehensive benefits package.

• 401(k) Plan.

• An inclusive workplace that promotes and values diversity.