Health Claims Specialist

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

📋 Description

• Execute medical claims processing through data entry for 90% of the workday

• Evaluate claims in accordance with production, quality, policy, procedure, and regulatory standards

• Follow up on claims that need further information

• Escalate problematic claims to a Lead and/or auditor for further examination

• Safeguard accurate and confidential information in line with HIPAA regulations

• Utilize specific software applications

• Fulfill designated special projects

• Achieve Key Performance Indicators and quality targets during training and thereafter

• Operate independently with access to a knowledge base and support personnel assistance

⛳️ Requirements

• High School Diploma or equivalent

• Medical Billing and Coding degree/certification

• Prior experience in a medical office environment, including familiarity with insurance, claims, billing, or coding

• Knowledge of Medicare/Medicaid and/or Child Plus

• Proficient understanding of medical terminology

• Strong data entry capabilities

• Effective time management skills

• Keen attention to detail

• Strong analytical skills

• Reliable internet connectivity: minimum 2 Mbps upload and 10 Mbps download

• A home network with a hard-wired internet connection; wireless and/or satellite internet are not acceptable

• A quiet, distraction-free, and secure workspace

• Proficient verbal and written communication skills

• Strong typing and analytical skills

• Ability to multitask with a strong focus on detail

• General computer proficiency

• Minimum typing speed of 40 words per minute on a typing test

• Clean and paperless work environment

• Availability to work Monday–Friday, from 8:30 AM to 5:00 PM EST

🏝️ Benefits

• Potential to earn an additional $1500 per month in bonuses

• Comprehensive medical, dental, and vision insurance plans

• Paid training opportunities

• Paid time off (PTO)

• Global Flexible Vacation Policy

• Company-provided equipment for work

• Opportunities for career advancement

• Monthly rewards and recognition programs

• Employee discounts

• Employee Assistance Program (EAP) and Health and Wellness initiatives

• Dedicated personal trainer for Sutherland employees

• Consistent weekday schedule, Monday – Friday, from 8:30 AM to 5:00 PM EST