Claims Representative, Healthcare

Role Overview

• Review and process insurance claims accurately using internal guidelines and benefit plans
• Research and navigate multiple systems and documents to validate claim details
• Confirm required documentation is included and identify missing information
• Verify accuracy of medical coding (CPT/ICD-10 preferred)
• Evaluate eligibility, coverage, authorizations, and coordination of benefits
• Identify discrepancies and resolve errors using established procedures
• Maintain productivity and quality standards in a fast-paced environment
• Work independently while collaborating with supervisors, coaches, and trainers
• Use multiple computer applications and virtual tools such as Outlook, Webex, and internal systems
• Continuously improve efficiency through feedback and training support

Requirements

• High school diploma or equivalent
• Ability to quickly learn new systems and processes
• Experience using Microsoft Outlook (email, calendar invites, attachments)
• Basic Microsoft Excel skills (sorting/filtering)
• Ability to navigate multiple systems using shortcuts and efficient workflows
• Strong attention to detail and ability to follow complex procedures
• Excellent time management and organizational skills
• Ability to meet productivity and quality performance expectations
• Experience working independently in a remote environment preferred
• Familiarity with healthcare terminology, insurance claims, CPT or ICD-10 coding preferred
• Previous claims processing or related administrative experience preferred

Benefits

• Competitive pay: $16.00-$17.00/hour
• Performance-based incentives
• Paid training in a cutting-edge virtual training environment
• Comprehensive health coverage (available after 90 days)
• Employee wellness and engagement programs.
• Career advancement opportunities: 90% of our leaders started as Customer Service Representatives