Health Claims Specialists

Position Overview

This is a fulltime permanent healthcare claims adjudicator position – a fully remote role available from Texas (USA). In this data entry position, you will process medical claims per specific client requirements while ensuring adherence to Key Performance Indicators and Quality goals. You will work independently with the support of a knowledge base and support personnel. Note that this is not a customer service or customer facing position.

Key Responsibilities

• Work independently, processing claims via data entry for 90% of your day.
• Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy, procedures, and regulatory guidelines.
• Follow up on claims needing additional information.
• Refer problem claims to a Lead and/or auditor for additional review.
• Ensure that all information remains accurate and confidential according to HIPPA guidelines.
• Operate and work with specific software required for claims processing.
• Undertake special projects as assigned.

Required Qualifications

• Data entry
• Time management
• Attention to detail
• Analytical skills
• High School Diploma or equivalent
• Excellent Internet Connectivity: Internet access speed of 2 Mbps upload and 10 Mbps download; must have a hardwired connection (wireless and/or satellite ISPs are not compatible)
• A quiet, distraction-free, and secure place to work
• Effective verbal and written communication skills
• Strong typing abilities with a minimum of 40 words per minute
• Multitasking skills with strict attention to detail
• General computer knowledge
• Must maintain a clean, paper-free work environment in accordance with company policies
• Medical Billing and Coding degree/certification
• Previous experience in a medical office setting, with knowledge of insurance, claims, billing or coding (including Medicare, Medicaid and/or Child Plus)
• Knowledge of medical terminology

Benefits & Perks

• Compensation: Pay rate of $13.50/hour with the opportunity to earn an additional bonus of $1500 a month.
• Medical, dental, and vision plans
• Paid training and PTO (ask about our Global Flexible Vacation Policy)
• Company-provided equipment
• Advancement opportunities – 80% of our frontline leaders have been promoted from within
• Monthly rewards & recognition programs
• Employee discounts
• EAP and Health and Wellness programs, including a personal trainer dedicated to Sutherland
• Weekday schedule: Monday – Friday, 8:30 AM – 5:00 PM EST