Claims Representative - Medical Claims Resolution and Customer Support in a Remote Setting

Join Our Team as a Claims Representative and Embrace a Modern, Remote Work Style We are excited to announce an excellent opportunity for a detail-oriented and customer-focused Claims Representative to join our team in a fully remote setting. As a Claims Representative, you will play a critical role in processing and managing medical claims, ensuring accuracy and efficiency in claims resolution. This is a fantastic chance to work in a dynamic and supportive environment, utilizing your skills and experience to drive success in the insurance industry. About Our Company and Culture Our company is committed to providing exceptional customer service and support in the insurance industry. We value a culture of collaboration, innovation, and continuous learning, and we are looking for team members who share these values. As a remote employee, you will be part of a virtual team that is connected and engaged, with regular opportunities for communication and feedback. We prioritize work-life balance and offer a flexible work environment that allows you to thrive in your personal and professional life. Job Overview We are seeking a highly organized and detail-oriented Claims Representative to join our team. The successful candidate will be responsible for reviewing and processing health insurance claims for accuracy and completeness, utilizing financial software to assess and calculate claim amounts, and maintaining medical records and documentation related to claims. This is a full-time position with a competitive salary range of $54,007.00 - $58,516.00 per year. Key Responsibilities Review and process health insurance claims for accuracy and completeness, ensuring timely and efficient claims resolution. Utilize financial software to assess and calculate claim amounts, applying ICD-9 coding to claims as necessary. Maintain accurate and up-to-date medical records and documentation related to claims. Verify insurance coverage and eligibility for claimants, ensuring proper insurance verification procedures are followed. Collaborate with medical billing teams for claim processing, and communicate effectively with claimants and internal teams. Provide exceptional customer service, responding to inbound and outbound calls, emails, and other inquiries. Develop and maintain a strong understanding of Workers' Compensation laws and regulations, and apply this knowledge to claims processing. Utilize Microsoft Excel and other software applications to manage and analyze data, identify trends, and optimize claims processing. Requirements and Qualifications Essential Qualifications Previous experience in clerical roles within the insurance or healthcare industry, preferably in a call center or claims processing environment. Proficiency in financial software for claims processing, including Microsoft Excel. Strong attention to detail and accuracy in claim assessment, with excellent communication and interpersonal skills. Ability to work in a fast-paced, dynamic environment, prioritizing multiple tasks and deadlines. High school diploma or equivalent required; associate's or bachelor's degree in a related field preferred. Preferred Qualifications 1 year of experience in Microsoft Office, customer service, call center, medical/healthcare claims, or Microsoft Excel. Knowledge of Workers' Compensation laws and regulations. Experience with ICD-9 coding and medical terminology. Certification in claims processing or a related field. Skills and Competencies Key Skills Excellent communication and interpersonal skills, with the ability to interact effectively with claimants, internal teams, and medical billing teams. Strong analytical and problem-solving skills, with attention to detail and accuracy. Proficiency in Microsoft Excel and other software applications, with the ability to learn new systems and technologies. Ability to work independently in a remote setting, with minimal supervision. Strong organizational and time management skills, with the ability to prioritize multiple tasks and deadlines. Career Growth Opportunities and Learning Benefits We are committed to the growth and development of our team members, offering regular training and education opportunities to support your career goals. As a Claims Representative, you will have the opportunity to: Develop your skills and knowledge in claims processing, medical terminology, and Workers' Compensation laws. Advance to leadership or specialized roles within the company. Participate in ongoing training and education programs to stay up-to-date with industry developments and best practices. Work Environment and Company Culture We offer a flexible and supportive work environment, with a focus on work-life balance and employee well-being. As a remote employee, you will have the opportunity to work from home, enjoying a comfortable and productive work environment. Our company culture is built on values of: Collaboration and teamwork. Innovation and continuous learning. Customer focus and exceptional service. Integrity and accountability. Compensation, Perks, and Benefits We offer a competitive salary range of $54,007.00 - $58,516.00 per year, along with a comprehensive benefits package, including: Opportunity to work from home in a remote setting. 8-hour shift, Monday to Friday. Paid time off and holidays. Opportunity for career growth and professional development. Conclusion and Call to Action If you are a motivated and detail-oriented individual with a passion for customer service and claims processing, we encourage you to apply for this exciting opportunity. Don't hesitate to submit your application, even if you don't meet every single requirement – we value a great attitude and a willingness to learn above all. Apply now and join our team as a Claims Representative, working in a dynamic and supportive remote environment. Apply To This Job Apply for this job