Claims Representative

This is a fully remote position, open to applicants in Arizona, +6 more states.

📋 Description

• Conduct manual reviews and processing of medical, supplemental, or dental claims.

• Investigate and maneuver through documents and databases to ensure claims are processed accurately and adhere to established guidelines.

• Verify that all necessary documents are included in submitted claims.

• Validate medical codes present in claim submissions.

• Evaluate the eligibility of claims.

• Review and confirm details regarding other insurance coverage.

• Assess authorizations for correctness.

• Analyze account benefit plans to guarantee claims conform to coverage and policies.

• Detect discrepancies, errors, or missing information.

• Operate multiple computer applications simultaneously.

• Work autonomously without close oversight while maintaining productivity and quality standards.

• Achieve or surpass quality and productivity targets.

• Collaborate with supervisors, coaches, and trainers to refine claim-processing techniques and workflows.

• Utilize Outlook, Cisco Webex, and similar virtual tools for collaboration and communication with colleagues and supervisors.

⛳️ Requirements

• High school diploma or equivalent required.

• Ability to rapidly learn various computer applications.

• Experience in sending and receiving emails, scheduling appointments, sending invitations, and attaching files using Microsoft Outlook.

• Familiarity with basic Microsoft Excel functions, such as filtering and sorting.

• Experience in navigating multiple computer applications using shortcut keys and other methods.

• Detail-oriented with a background in applying complex policy and procedure documents.

• Strong organizational skills with the capability to prioritize tasks ahead of deadlines.

• Proven track record of meeting quality and productivity performance standards.

• Preferred experience working independently in a virtual environment.

• Preferred experience with medical and insurance terminology in a professional context.

• Familiarity with CPT/ICD-10 codes is preferred.

• Proven experience in health insurance claims processing or a similar field is preferred.

• Reliable home internet connection via cable broadband or fiber optic service with a minimum of 10 Mbps download and 5 Mbps upload speed.

🏝️ Benefits

• Medical, vision, and dental benefits starting from day one.

• Access to well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence available.

• Eligibility for an annual bonus plan.

• Comprehensive training program including virtual classroom instruction, on-the-job learning, and constructive feedback.