Insurance Account Resolution Specialist

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

📋 Description

• Conduct research and resolve unresolved insurance claims, including those that are pending, unable to be processed, denied, or incorrectly paid by commercial insurance carriers.

• Investigate claims that are on hold by identifying root causes, correcting errors, and executing necessary follow-up actions to facilitate claims processing.

• Analyze insurance denials by determining the reasons for denial, assessing their validity, and completing appropriate resolution steps such as appeals, corrections, or resubmissions.

• Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and obtain detailed explanations for pending or denied claims.

• Prepare and submit any additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing.

• Draft and submit appeals when necessary, ensuring they are backed by proper documentation, regulatory guidelines, and payer-specific requirements.

• Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds.

• Maintain accurate and detailed notes in billing systems for all follow-up activities, findings, and next steps.

• Identify trends or recurring issues, escalating concerns to supervisors or the appropriate internal teams to support process improvement.

• Meet daily productivity and accuracy expectations, contributing to a high-performing team environment.

• Perform additional job duties as assigned.

⛳️ Requirements

• Education: High School Diploma or equivalent is required.

• Strong computer skills, including proficiency in MS Outlook, Word, and Excel.

• Ability to type 40 WPM with accuracy.

• Proven capability to handle high-volume workloads, prioritize effectively, and meet tight deadlines.

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

• Strong verbal communication skills with the ability to maintain composure, professionalism, and effectiveness during phone interactions with insurance carriers.

• Excellent written communication skills for creating clear and accurate documentation and correspondence.

• Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings.

• Highly organized, self-paced, and able to manage work independently in a remote environment.

• Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when necessary.

• Ability to independently manage all aspects of the job role, including required goals and business practices in a remote setting.

🏝️ Benefits

• Comprehensive benefits package.

• 401(k) Plan.