Claims Processor

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

📋 Description

• Review and process insurance claims by confirming policy coverage, collecting necessary information, assessing claim legitimacy, and determining payout amounts according to policy provisions.

• Ensure all documentation is thorough and precise while complying with company policies and regulatory standards.

• Engage with policyholders, agents, and other parties to streamline the claims process.

• Uphold compliance with HIPAA confidentiality requirements.

• Provide support to various departments, including litigation and legal teams.

• Perform account searches and acquire police reports as needed.

• Initiate contact and document files upon receipt of the first notice of loss.

• Distribute the necessary claim forms to claimants, insured individuals, and their representatives.

• Review files to ensure proper reserves and maintain accurate documentation.

• Request any missing documentation essential for effective file management.

• Assist litigation and legal teams with disputes, appeals, and pre-suit matters.

• Aid in post-service appeals, assignments, dispute resolutions, awards, settlements, and withdrawals.

• Process appropriate payments for awards, settlements, and relevant interest.

• Redirect documentation when a claim is absent from the system.

• Conduct cycle-time file reviews to identify missing or pending documents, manage open billing, and facilitate file closure.

• Oversee daily operations to ensure client SLA-defined standard operating procedures (SOPs) are adhered to.

⛳️ Requirements

• A bachelor’s degree or relevant experience is required.

• Prior experience in a carrier or as an adjuster is preferred.

• Familiarity with New Jersey No-Fault PIP regulations; 2–3 years preferred.

• A minimum of 2 years of experience in medical billing or claims processing is necessary.

• Strong organizational skills with keen attention to detail.

• Ability to conduct interactions with sensitivity, maturity, and professionalism.

• Knowledge of claims systems and procedures.

• Exceptional written and verbal communication skills.

• Capacity to maintain confidentiality of information.

• Comfortable working in a high-volume, fast-paced, team-oriented environment.

• Proficient in Microsoft Office Suite.

• Ability to navigate multiple claim systems effectively.

• Capability to adhere to SOPs as outlined in client SLAs.

• Full-time availability required, Monday–Friday, from 8:00 a.m. to 4:30 p.m.

🏝️ Benefits

• Competitive salary with opportunities for growth.

• Comprehensive health and wellness benefits.

• Supportive team environment with ongoing training and development.