Claims Processor - Work from Home

Sagility; United States; Remote; USD 35,000 - 45,000; Full time

Benefits offered by this job

Medical, Dental, and Vision coverage

401(k) with employer contribution

Paid Time Off (PTO)

Job summary

Local First Arizona is looking for a Claims Processor to join our remote team. You will handle the submission, review, and resolution of medical claims, ensuring accuracy and compliance with policies.

The ideal candidate has at least one year of relevant experience and familiarity with medical coding and claim forms. Strong communication skills and proficiency in Microsoft applications are essential. This position offers a starting pay of $17 per hour with various benefits including medical coverage and a 401(k).

Qualifications

• Minimum of one year of recent experience processing medical claims.
• Familiarity with medical claim forms, including CMS-1500 and UB-04.
• Working knowledge of coding systems: ICD-10, HCPCS, and CPT.

Responsibilities

• Review medical claims to ensure no missing or incomplete information.
• Navigate systems to research and process claims accurately.
• Determine if claims should be paid or denied, and complete denial letters.

Skills

Medical claims processing experience

Familiarity with CMS-1500 and UB-04 forms

Knowledge of ICD-10, HCPCS, and CPT coding systems

Proficient in Microsoft Windows and Excel

Strong verbal and written communication skills

Ability to focus in a high-volume environment

Education

High School Diploma or equivalent

Tools

Web-based tools and platforms

Job description

Job Title

Claims Processor – Work from Home

Overview

Sagility, through its subsidiary BroadPath, is seeking experienced medical Claims Processors to join our remote team. In this role you will be responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex.

Responsibilities

• Review medical claims thoroughly to ensure no missing or incomplete information.
• Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations).
• Apply appropriate benefits to each claim in accordance with claims processing policies, grievance procedures, state mandates, CMS guidelines, and benefit plan documents.
• Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received.
• Determine if claims should be paid or denied, and complete denial letters when applicable.

Qualifications

• Minimum of one year of recent experience processing medical claims for a health insurance company or payer.
• Familiarity with medical claim forms (CMS-1500 and UB-04).
• Working knowledge of coding systems: ICD-10, HCPCS, and CPT.
• Proficient in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and web‑based tools and platforms.
• Excellent verbal and written communication skills.
• Ability to remain focused and productive in a high‑volume, repetitive task environment.
• High School Diploma or equivalent.

Schedule

Schedules may fall between the hours of Monday‑Friday, 8:00AM – 10:00PM Eastern Time, and will be assigned based on business needs.

Compensation

Base Pay: Starting at $17 per hour. Pay frequency: Weekly.

Benefits

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short‑Term and Long‑Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.

What to Expect

On‑camera participation during interviews, training, team meetings, and regular check‑ins. Face‑to‑face discussions sparking collaboration and engagement. A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions.

Diversity & Inclusion

BroadPath, a Sagility Company, embraces individuals from all backgrounds and fosters an inclusive environment where everyone feels valued and empowered.

Equal Employment Opportunity

BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants based on race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Accommodation for Disabilities

If you need accommodation due to a disability, please email us at [e-mail]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.

Location

Work@Home – United States of America