Claims Processor

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

📋 Description

• Review and process insurance claims by verifying policy coverage, gathering necessary information, assessing the validity of claims, and determining suitable payout amounts.

• Ensure that documentation is complete and accurate while complying with company guidelines and regulations.

• Engage with policyholders, agents, and other stakeholders to facilitate the claims process effectively.

• Guarantee adherence to HIPAA regulations and confidentiality standards.

• Operate within multiple claims systems and provide support to various departments, including litigation and legal teams.

• Perform account searches and obtain police reports as necessary.

• Make initial contact and document files upon receiving the first notice of loss.

• Dispatch appropriate claim forms to claimants, insured individuals, and/or representatives.

• Review files for accurate reserves and ensure proper documentation.

• Request any missing documentation required to manage files effectively.

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

• Support post-service appeals, assignments, disputes, awards, settlements, and/or withdrawals.

• Process appropriate payments for awards, settlements, and interest when applicable.

• Redirect documentation when a claim is not present in the system.

• Conduct cycle-time file reviews for missing or pending documents, open billing, and file closure.

• Oversee daily operations to ensure adherence to SOPs as defined in clients’ SLAs.

⛳️ Requirements

• Exceptional organizational skills and meticulous attention to detail.

• Conduct interactions with sensitivity, maturity, and professionalism.

• Familiarity with claims systems and procedures.

• Outstanding written and verbal communication abilities.

• Capability to maintain confidential information securely.

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

• Proficient in Microsoft Office Suite.

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

• Previous experience as a carrier or adjuster is preferred.

• Knowledge of New Jersey No Fault PIP regulations.

• Preferred 2-3 years of experience related to New Jersey No Fault PIP regulations.

• Minimum of 2 years of experience in medical billing or claims processing.

• Availability to work 20 hours a week.

• Ability to work 100% remotely.

🏝️ Benefits

• Competitive salary and compensation package.

• Flexible work schedule with remote work options.

• Opportunities for career growth and professional development.

• Comprehensive health benefits and insurance coverage.

• Supportive and collaborative work environment.