Claims Processor

Jobtailor; Deutschland; Remote; EUR 42.000 - 56.000; Vollzeit

Zusammenfassung

Jobtailor seeks an experienced Insurance Claims Processor in Germany to verify policy coverage, gather information, and determine payouts in line with regulations. You will handle medical billing basics, maintain confidential records, and coordinate with policyholders and agents to move claims forward.

Responsibilities include supporting legal and litigation teams, ensuring file accuracy, and following SOPs in a fast-paced environment. Strong communication and detail orientation are essential.

Qualifikationen

• Bachelor’s degree or equivalent experience is required.
• Experience in insurance claims and medical billing preferred.
• Strong organization and communication skills are essential.

Aufgaben

• Review and process insurance claims by verifying coverage and payout amounts.
• Ensure documentation is complete and compliant with guidelines.
• Interact with policyholders, agents, and stakeholders to facilitate claims.
• Maintain HIPAA confidentiality and support litigation/legal departments.
• Conduct cycle-time file reviews and ensure SOP adherence.

Kenntnisse

Insurance Claims Processing

Medical Billing

Attention To Detail

Excellent Written And Verbal Skills

Ausbildung

Bachelor’s degree or relevant experience

Tools

Microsoft Office Suite

Claims Systems Knowledge

Jobbeschreibung

• • Review and process insurance claims by verifying policy coverage, gathering information, evaluating claim validity, and determining payout amounts based on policy terms
• • Ensure documentation is complete and accurate while adhering to company guidelines and regulations
• • Interact with policyholders, agents, and other stakeholders to facilitate the claims process
• • Maintain compliance with HIPAA confidentiality requirements
• • Support multiple departments, including litigation and legal departments
• • Conduct account searches and obtain police reports
• • Make initial contact and document files upon receipt of first notice of loss
• • Send appropriate claim forms to claimants, insureds, and representatives
• • Review files for proper reserves and document files
• • Request missing documentation needed to manage files
• • Support litigation/legal departments with disputes, appeals, and pre-suits
• • Support post-service appeals, assignments, dispute awards, settlements, and withdrawals
• • Make appropriate payments for awards, settlements, and applicable interest
• • Reroute documentation when a claim is not in the system
• • Conduct cycle-time file reviews for missing or pending documents, open billing, and file closure
• • Manage day-to-day operations to ensure client SLA-defined SOPs are followed

Requirements

• Bachelor’s degree or relevant experience required
• Prior carrier or adjuster experience
• Knowledge of New Jersey No Fault PIP regulation; 2–3 years preferred
• Minimum 2 years medical billing or claims processing background
• Excellent organizational skills and attention to detail
• Interactions conducted with sensitivity, maturity and professionalism
• Knowledge of claims systems and procedures
• Excellent written and verbal communication skills
• Ability to maintain confidential information
• Comfortable in a high-volume, fast, team-oriented environment
• Proficient in Microsoft Office Suite
• Ability to work in multiple claim systems
• Ability to follow SOPs as defined in clients’ SLAs
• Full-time availability, Monday–Friday, 8:00 a.m.–4:30 p.m.

Core Competencies

Demonstrates expertise in insurance claims processing, including knowledge of New Jersey No Fault PIP regulation and medical billing. Proficient in maintaining compliance with HIPAA requirements while ensuring accurate documentation and effective communication with stakeholders.

Highest-signal resume keywords

• Insurance Claims Processing
• New Jersey No Fault PIP Regulation
• Medical Billing
• Excellent Written And Verbal Communication Skills
• Microsoft Office Suite

Hard Skills

• Claims Processing
• Policy Coverage Verification
• Documentation Accuracy
• Claims Systems Knowledge
• Account Searches
• File Management
• Cycle-Time File Reviews
• SOP Adherence
• Payout Determination
• Claims Evaluation

Soft Skills

• Excellent Organizational Skills
• Attention To Detail
• Professionalism
• Sensitivity In Interactions
• Team-Oriented

Industry Keywords

• HIPAA Compliance
• Insurance Regulations
• Claims Processing Guidelines
• Litigation Support
• Dispute Management

Tools & Technologies

• Claims Systems
• Microsoft Office Suite